Infectious Disease Modelling of HIV Prevention Interventions: A Systematic Review and Narrative Synthesis of Compartmental Models

Abstract

Background The HIV epidemic remains a major public health problem. Critical to transmission control are HIV prevention strategies with new interventions continuing to be developed. Mathematical models are important for understanding the potential impact of these interventions and supporting policy decisions. This systematic review aims to answer the following question: when a new HIV prevention intervention is being considered or designed, what information regarding it is necessary to include in a compartmental model to provide useful insights to policy makers? The primary objective of this review is therefore to assess suitability of current compartmental HIV prevention models for informing policy development. Methods Articles published in EMBASE, Medline, Econlit, and Global Health were screened. Included studies were identified using permutations of (i) HIV, (ii) pre-exposure prophylaxis (PrEP), circumcision (both voluntary male circumcision [VMMC] and early-infant male circumcision [EIMC]), and vaccination, and (iii) modelling. Data extraction focused on study design, model structure, and intervention incorporation into models. Article quality was assessed using the TRACE (TRAnsparent and Comprehensive Ecological modelling documentation) criteria for mathematical models. Results Of 837 articles screened, 48 articles were included in the review, with 32 unique mathematical models identified. The substantial majority of studies included PrEP (83%), whilst fewer modelled circumcision (54%), and only a few focussed on vaccination (10%). Data evaluation, implementation verification, and model output corroboration were identified as areas of poorer model quality. Parameters commonly included in the mathematical models were intervention uptake and effectiveness, with additional intervention-specific common parameters identified. We identified key modelling gaps; critically, models insufficiently incorporate multiple interventions acting simultaneously. Additionally, population subgroups were generally poorly represented—with future models requiring improved incorporation of ethnicity and sexual risk group stratification—and many models contained inappropriate data in parameterisation which will affect output accuracy. Conclusions This review identified gaps in compartmental models to date and suggests areas of improvement for models focusing on new prevention interventions. Resolution of such gaps within future models will ensure greater robustness and transparency, and enable more accurate assessment of the impact that new interventions may have, thereby providing more meaningful guidance to policy makers. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-023-01260-z.

Mathematical modelling to estimate the impact of maternal and perinatal healthcare services and interventions on health in sub-Saharan Africa: A scoping review

“…Undoubtedly, widening the studies inclusion criteria so that such studies were reviewed would likely have changed the results of this review. This is particularly true given the proliferation of HIV models used to conduct research in SSA (125,126). Finally, this review did not explicitly consider the quality of included studies by conducting a critical appraisal as part of the review process.…”

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

“…and Giddings et al. [ 32 , 33 ]. We chose 2010 because clinical trials for daily oral PrEP were underway, and many countries were already considering ways to incorporate PrEP into national HIV plans, pending proven safety and efficacy.…”

“…average or incremental) or economic evaluation outcomes, such as cost-effectiveness, cost-benefit, or cost-utility; (4) was conducted in any LMIC (classified using World Bank categorizations [31]); and (5) was published in English. We compared our final study sample with other recent reviews on the modelling and cost-effectiveness of biomedical HIV prevention by Bozzani et al and Giddings et al [32,33]. We chose 2010 because clinical trials for daily oral PrEP were underway, and many countries were already considering ways to incorporate PrEP into national HIV plans, pending proven safety and efficacy.…”