Assessing the utility of the tipping point ratio to monitor HIV treatment programmes in the era of universal access to ART  

作　　者：Simon de Montigny Marie-Claude Boily Benoît RMasse Kate M.Mitchell Dobromir T.Dimitrov 

机构地区：[1]CHU Sainte-Justine Research Center,Montreal,QC,Canada [2]School of Public Health,University of Montreal,Montreal,QC,Canada [3]Department of Infectious Disease Epidemiology,Imperial College,London,United Kingdom [4]Fred Hutchinson Cancer Research Center,Seattle,WA,United States

出　　处：《Infectious Disease Modelling》2018年第1期85-96,共12页传染病建模（英文）

基　　金：SM,BRM and DTD are supported by the Bill and Melinda Gates Foundation(OPP1110049);MCB,KMM and DTD are supported through the HPTN Modeling Center by subcontract from SDMC:HIV Prevention Trials Network funded by the U.S.National Institutes of Health(NIH UM1 AI068617).

摘　　要：Background:The epidemiological tipping point ratio(TPR)has been suggested as a useful indicator to monitor the scale-up of antiretroviral treatment(ART)programmes and determine when scale-up is sufficient to control the epidemic.TPR has been defined as the ratio of yearly number of new HIV infections to the yearly number of new ART initiations or to the yearly net increase in the number of people on ART.It has been used to rank the progress of treatment programmes across countries,with the objective of reaching a TPR value under 1.Our study aims to assess if TPR alone can be used as an indicator of ART success across settings by comparing the expected changes in HIV incidence and ART coverage when TPR is maintained constant over time.In particular,we focus on the effect of ART initiation timing(emphasis on ART being initiated early or late during HIV progression)on the interpretation of the TPR.Methods:We used a dynamic model of HIV transmission in South Africa representing ART rollout leading to universal treatment in 2017.The model is calibrated to HIV incidence,HIV prevalence and ART coverage in 2012 in South Africa,and 1000 simulations are selected for the base-case scenario.To measure the effect of TPR,we simulate TPRpreserving interventions,maintaining TPR(yearly number of new ART initiations denominator)at the value observed in 2019(between 0.65 and 1.25)for 15 years.We compare ART coverage and HIV incidence across TPR values and across strategies in which ART access is prioritized differently.In a secondary analysis,we illustrate the sensitivity of new ART initiations to ART retention,and we compare both definitions of the TPR.Results:Our analysis shows that HIV incidence reduction is weakly correlated to TPR:the same reduction in HIV incidence(15%)can be achieved by implementing the same strategy with a wide range of TPR maintained(0.65e1.12).Assuming high retention in ART,TPR-preserving strategies prioritizing early ART initiation yield greater reduction in HIV incidence than strategies where most indiv

关 键 词：treatment maintained RETENTION 

分 类 号：R51[医药卫生—内科学]