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

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Infectious Disease Modelling 2018年第1期3卷 85-96页

作者： Simon de Montigny Marie-Claude Boily benoît rmasse Kate M.Mitchell Dobromir t.Dimitrov CHU Sainte-Justine Research Center MontrealQCCanada School of Public Health University of MontrealMontrealQCCanada Department of Infectious Disease Epidemiology Imperial CollegeLondonUnited Kingdom Fred Hutchinson Cancer Research Center SeattleWAUnited States

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 *** 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 *** has been used to rank the progress of treatment programmes across countries,with the objective of reaching a tPR value under *** 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 *** 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 ***:We used a dynamic model of HIV transmission in South Africa representing ARt rollout leading to universal treatment in *** 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 *** 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 *** compare ARt coverage and HIV incidence across tPR values and across strategies in which ARt access is prioritized *** a secondary analysis,we illustrate the sensitivity of new ARt initiations to ARt retention,and we compare both definitions of the ***: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 i

关键词： treatment maintained retention

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