Mother-to-child transmission of HIV: a simulation-based approach for the evaluation of intervention strategies

Vieira, Israel Teixeira; Harper, Paul Robert; Shahani, A. K.; Senna, Valter de

doi:10.1057/palgrave.jors.2601566

Cited by 16 publications

(14 citation statements)

References 4 publications

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“…hospital bed capacities, [6][7][8] scheduling of operating theatres, 7 workforce planning, 7 modelling effectiveness of emergency admission wards, 8 ambulance response centre procedures, 8 critical care modelling, 9 HIV/AIDS epidemiological studies, 10,11 modelling treatment options for thrombolysis, 12 modelling of diabetic retinopathy. 13 Central to all these projects was the formation of a steering group from the relevant organizations that directed the work.…”

Section: Adoption Of the Frameworkmentioning

confidence: 99%

On the challenges of healthcare modelling and a proposed project life cycle for successful implementation

Harper

Pitt

2004

Journal of the Operational Research Society

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Section: Adoption Of the Frameworkmentioning

confidence: 99%

On the challenges of healthcare modelling and a proposed project life cycle for successful implementation

Harper

Pitt

2004

Journal of the Operational Research Society

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“…To date, several published analyses have reported on simulation models to estimate MTCT of HIV. Vieira et al developed a discrete-event, three-phase simulation, built in Visual Basic, with a stochastic semi-Markov structure to model different intervention strategies at any time, including short-course antiretroviral drugs and cessation of breastfeeding in Botswana [ 13 ]. Ciaranello et al used local trial and programmatic data to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe and to compare five PMTCT regimens at a fixed level of PMTCT medication uptake.…”

Section: Introductionmentioning

confidence: 99%

Estimating mother-to-child HIV transmission rates in Cameroon in 2011: a computer simulation approach

et al. 2015

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BackgroundDespite the progress in the Prevention of the Mother-to-Child Transmission of HIV (PMTCT), the paediatric HIV epidemic remains worrying in Cameroon. HIV prevalence rate for the population of pregnant women was 7.6 % in 2010 in Cameroon. The extent of the paediatric HIV epidemic is needed to inform policymakers. We developed a stochastic simulation model to estimate the number of new paediatric HIV infections through MTCT based on the observed uptake of services during the different steps of the PMTCT cascade in Cameroon in 2011. Different levels of PMTCT uptake was also assessed.MethodsA discrete events computer simulation-based approach with stochastic structure was proposed to generate a cohort of pregnant women followed-up until 6 weeks post-partum, and optionally until complete breastfeeding cessation in both prevalent and incident lactating HIV-infected women. The different parameters of the simulation model were fixed using data sources available from the 2011 national registry surveys, and from external cohorts in Cameroon. Different PMTCT coverages were simulated to assess their impact on MTCT. Available data show a low coverage of PMTCT services in Cameroon in 2011.ResultsBased on a simulation approach on a population of 995, 533 pregnant women, the overall residual MTCT rate in 2011 was estimated to be 22.1 % (95 % CI: 18.6 %–25.2 %), the 6-week perinatal MTCT rate among prevalent HIV-infected mothers at delivery is estimated at 12.1 % (95 % CI: 8.1 %–15.1 %), with an additional postnatal MTCT rate estimated at 13.3 % (95 % CI: 9.3 %–17.8 %). The MTCT rate among children whose mothers seroconverted during breastfeeding was estimated at 20.8 % (95 % CI: 14.1 %–26.9 %). Overall, we estimated the number of new HIV infections in children in Cameroon to be 10, 403 (95 % CI: 9, 054–13, 345) in 2011. When PMTCT uptake have been fixed at 100 %, 90 % and 80 %, global MTCT rate failed to 0.9 % (95 % CI: 0.5 %–1.7 %), 2.0 % (95 % CI: 0.9 %–3.2 %) and 4.3 % (95 % CI: 2.4 %–6.7 %) respectively.ConclusionsThis model is helpful to provide MTCT estimates to guide the national HIV policy in Cameroon. Increasing supply and uptake of PMTCT services among prevalent HIV infected pregnant women, as well as HIV-prevention interventions including the offer and acceptance of HIV testing and counselling in lactating women could reduce significantly the residual HIV MTCT in Cameroon. A public health effort should be made to encourage health care workers and pregnant women to use PMTCT services until complete breastfeeding cessation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1336-2) contains supplementary material, which is available to authorized users.

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“…First, we will include the effects of vaccination, since this is now a distinct possibility. 30 Another improvement will be to model HIV transmission during delivery more accurately, as in Vieira et al, 18 to account for differences in the probability of transmission due to duration of labour and parity (number of previous births). This will be straightforward to implement since these factors are already included in the current version of the model, but are not used at present.…”

Section: Discussionmentioning

confidence: 99%

Use of discrete-event simulation to evaluate strategies for the prevention of mother-to-child transmission of HIV in developing countries

Rauner

Brailsford

Fleßa

2005

Journal of the Operational Research Society

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HIV/AIDS affects over 40 million people worldwide, and more than 70% of these people live in Africa. Mother-to-child transmission of HIV accounts for over 90% of all HIV infections in children under the age of 15 years. However, implementing HIV prevention policies in Africa is extremely difficult because of the poor medical and socio-economic infrastructure. In this paper, we present a discrete-event simulation model that evaluates the relative benefits of two potentially affordable interventions aimed at preventing mother-to-child transmission of HIV, namely anti-retroviral treatment at childbirth and/or bottlefeeding strategies. The model uses rural Tanzanian data and compares different treatment policies. Our results demonstrate that strategic guidelines about breastfeeding are highly dependent on the assumed increase in infant mortality due to bottlefeeding, the efficacy of anti-retroviral treatment at childbirth, and the maternal health stage. The cost of averted infections, though low by Western standards, may represent significant obstacles to policy implementation in developing countries.

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Mother-to-child transmission of HIV: a simulation-based approach for the evaluation of intervention strategies

Cited by 16 publications

References 4 publications

On the challenges of healthcare modelling and a proposed project life cycle for successful implementation

On the challenges of healthcare modelling and a proposed project life cycle for successful implementation

Estimating mother-to-child HIV transmission rates in Cameroon in 2011: a computer simulation approach

Use of discrete-event simulation to evaluate strategies for the prevention of mother-to-child transmission of HIV in developing countries

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