Effects of education, vaccination and treatment on HIV transmission in homosexuals with genetic heterogeneity

Delay in budget allocation for vaccination and awareness induces chaos in an infectious disease model

In this paper, we propose a model to assess the impacts of budget allocation for vaccination and awareness programs on the dynamics of infectious diseases. The budget allocation is assumed to follow logistic growth, and its per capita growth rate increases proportional to disease prevalence. An increment in per-capita growth rate of budget allocation due to increase in infected individuals after a threshold value leads to onset of limit cycle oscillations. Our results reveal that the epidemic potential can be reduced or even disease can be eradicated through vaccination of high quality and/or continuous propagation of awareness among the people in endemic zones. We extend the proposed model by incorporating a discrete time delay in the increment of budget allocation due to infected population in the region. We observe that multiple stability switches occur and the system becomes chaotic on gradual increase in the value of time delay.

Optimization of Public Health Education Parameters for Controlling the Spread of HIV/AIDS Infection

Due to the prevalence of Human Immuno-deficiency Virus/Acquired Immuno-Deficiency Syndrome (HIV/AIDS) infection in society and the importance of preventing the spread of this disease, a mathematical model for sexual transmission of HIV/AIDS epidemic with asymptomatic and symptomatic phase and public health education is stated as a symmetric system of differential equations in order to reduce the spread of this infectious disease. It is demonstrated that public health education has a considerable effect on the prevalence of the disease. Moreover, the cost of education is very high and for this reason, a cost-optimal control is applied to provide the best possible combination of the parameters corresponding to education in controlling the spread of the disease by means of the Genetic Algorithm (GA) and Simulated Annealing (SA).

Dynamics of the impact of Twitter with time delay on the spread of infectious diseases

In this paper, a mathematical model to study the impact of Twitter in controlling infectious disease is proposed. The model includes the dynamics of “tweets” which may enhance awareness of the disease and cause behavioral changes among the public, thus reducing the transmission of the disease. Furthermore, the model is improved by introducing a time delay between the outbreak of disease and the release of Twitter messages. The basic reproduction number and the conditions for the stability of the equilibria are derived. It is shown that the system undergoes Hopf bifurcation when time delay is increased. Finally, numerical simulations are given to verify the analytical results.

Modeling the effect of time delay in budget allocation to control an epidemic through awareness

The emergence of any new infectious disease poses much stress on the government to control the spread of such disease. The easy, fast and less expensive way to slow down the spread of disease is to make the population be aware of its spread and possible control mechanisms. For this purpose, government allocates some funds to make public aware through mass media, print media, pamphlets, etc. Keeping this in view, in this paper, a nonlinear mathematical model is proposed and analyzed to assess the effect of time delay in providing funds by the government to warn people. It is assumed that susceptible individuals contract infection through the direct contact with infected individuals; however the rate of contracting infection is a decreasing function of funds availability. The proposed model is analyzed using stability theory of delay differential equations and numerical simulations. The model analysis shows that the increase in funds to warn people reduces the number of infected individuals but delay in providing the funds destabilizes the interior equilibrium and may cause stability switches.

Frequent implementation of interventions may increase HIV infections among MSM in China

Intervention measures among men who have sex with men (MSM) are usually designed to reduce the frequency of high risk behaviors (within-community level), but unfortunately may change the contact network and consequently increase the opportunity for them to have sex with new partners (between-community level). A multi-community periodic model on complex network is proposed to study the two-side effects of interventions on HIV transmission among MSM in China, in which the wanning process of the impacts of interventions are modelled. The basic reproduction number for the multi-community periodic system is defined and calculated numerically. Based on the number of annual reported HIV/AIDS cases among MSM in China, the unknown parameters are estimated by using MCMC method and the basic reproduction number is estimated as 3.56 (95%CI [3.556, 3.568]). Our results show that strong randomness of the community-connection networks leads to more new infections and more HIV/AIDS cases. Moreover, main conclusion indicates that implementation of interventions may induce more new infections, depending on relative level of between- and within-community impacts, and the frequency of implementation of interventions. The findings can help to guide the policy maker to choose the appropriate intervention measures, and to implement the interventions with proper frequency.

Modelling effects of public health educational campaigns on drinking dynamics

This paper deals with the global property of a drinking model with public health educational campaigns. With the help of Lyapunov function, global stability of equilibria of the model is derived. The alcohol-free equilibrium is globally asymptotically stable and the alcohol problems are eliminated from population if [Formula: see text]. A unique alcohol present equilibrium is globally asymptotically stable if [Formula: see text]. Furthermore, the basic reproductive [Formula: see text] for the model is compared with the basic reproductive number [Formula: see text] for the absence of public health educational campaigns. We conclude that the public health educational campaigns of drinking individuals can slow down the drinking dynamics. Some numerical simulations are also given to explain our conclusions.

Stability analysis and optimal control of an epidemic model with awareness programs by media

The impact of awareness campaigns and behavioral responses on epidemic outbreaks has been reported at times. However, to what extent does the provision of awareness and behavioral changes affect the epidemic trajectory is unknown, but important from the public health standpoint. To address this question, we formulate a mathematical model to study the effect of awareness campaigns by media on the outbreak of an epidemic. The awareness campaigns are treated as an intervention for the emergent disease. These awareness campaigns divide the whole populations into two subpopulation; aware and unaware, by inducing behavioral changes amongst them. The awareness campaigns are included explicitly as a separate dynamic variable in the modeling process. The model is analyzed qualitatively using stability theory of differential equations. We have also identified an optimal implementation rate of awareness campaigns so that disease can be controlled with minimal possible expenditure on awareness campaigns, using optimal control theory. The control setting is investigated analytically using optimal control theory, and the numerical solutions illustrating the optimal regimens under various assumptions are also shown.

The importance of extended high viremics in models of HIV spread in South Africa

Recent studies found a substantial fraction of 'extended high viremics' among HIV-1 subtype C, the most common subtype in southern Africa. Extended high viremics are HIV infected individuals who maintain a high viral load for a longer time period than usual after the initial infection. They are more infectious during this period, and their infection progresses to full-blown AIDS and death much faster than usual. This study investigates the impact of extended high viremics on the spread of the HIV epidemic in South Africa. We develop a simple deterministic compartmental model for HIV infection that includes extended high viremics. As the available data on extended high viremics are limited, we parameterize this model using only the fraction of extended high viremics among new infections and the reduced life-span of extended high viremics. We find that without extended high viremics, the HIV prevalence in South Africa would have remained close to its 1990 level, instead of increasing to the current epidemic levels. We also find that the greater the fraction of extended high viremics among susceptibles, the greater the steady-state HIV prevalence and the more sensitive the steady-state prevalence is to the HIV transmission probability. These results suggest that extended high viremics have an impact on the HIV epidemic in South Africa; justify the need for comprehensive epidemiological studies since the current data is limited; and suggest that future models of HIV for southern Africa should explicitly model extended high viremics.

EFFECT OF AWARENESS PROGRAMS IN CONTROLLING THE PREVALENCE OF AN EPIDEMIC WITH TIME DELAY

A nonlinear mathematical model with delay to capture the dynamics of effect of awareness programs on the prevalence of any epidemic is proposed and analyzed. It is assumed that pathogens are transmitted via direct contact between susceptibles and infectives. It is assumed further that cumulative density of awareness programs increases at a rate proportional to the number of infectives. It is considered that awareness programs are capable of inducing behavioral changes in susceptibles, which result in the isolation of aware population. The model is analyzed using stability theory of differential equations and numerical simulations. The model analysis shows that, though awareness programs cannot eradicate infection, they help in controlling the prevalence of disease. It is also found that time delay in execution of awareness programs destabilizes the system and periodic solutions may arise through Hopf-bifurcation.

HIV/AIDS MODEL FOR ASSESSING THE EFFECTS OF PROPHYLACTIC STERILIZING VACCINES, CONDOMS AND TREATMENT WITH AMELIORATION

HIV/AIDS vaccination model for heterosexual transmission with explicit incubation period is presented as a system of delay differential equations. The model considers prophylactic vaccination of sexually immature (pre- and early-adolescents) and mature susceptibles in a community. We start by formulating and analyzing an HIV/AIDS vaccination model that we extend to incorporate condom use based on efficacy and compliance. Further, we extend HIV/AIDS vaccination model with condom use by incorporating treatment which allows AIDS patients to undergo amelioration. The thresholds and equilibria for the models are determined, and stabilities analyzed. The basic reproductive numbers for the models are computed and compared to assess the possible community benefits of using prophylactic vaccines, condoms and treatment with amelioration of AIDS patients. We conclude from the study that vaccination and condom use can reduce the basic reproductive number [Formula: see text] to values below unity but treatment with amelioration intended to lengthen the lives of AIDS patients may result in more numbers of HIV infections and fail to reduce [Formula: see text] to values less than unity as intended for disease control.

Mathematical models for the study of HIV spread and control amongst men who have sex with men

For a quarter of century, mathematical models have been used to study the spread and control of HIV amongst men who have sex with men (MSM). We searched MEDLINE and EMBASE databases up to the end of 2010 and reviewed this literature to summarise the methodologies used, key model developments, and the recommended strategies for HIV control amongst MSM. Of 742 studies identified, 127 studies met the inclusion criteria. Most studies employed deterministic modelling methods (80%). Over time we saw an increase in model complexity regarding antiretroviral therapy (ART), and a corresponding decrease in complexity regarding sexual behaviours. Formal estimation of model parameters was carried out in only a small proportion of the studies (22%) while model validation was considered by an even smaller proportion (17%), somewhat reducing confidence in the findings from the studies. Nonetheless, a number of common conclusions emerged, including (1) identification of the importance of assumptions regarding changes in infectivity and sexual contact rates on the impact of ART on HIV incidence, that subsequently led to empirical studies to gather these data, and (2) recommendation that multiple strategies would be required for effective HIV control amongst MSM. The role of mathematical models in studying epidemics is clear, and the lack of formal inference and validation highlights the need for further developments in this area. Improved methodologies for parameter estimation and systematic sensitivity analysis will help generate predictions that more fully express uncertainty, allowing better informed decision making in public health.

Epidemiological models with prevalence dependent endogenous self-protection measure

A simple mathematical model for human disease epidemics that takes the human learning behaviour and self-protective measures into account is proposed and investigated. We have analysed the effect of endogenous self-protective measures with respect to the prevalence level of the disease and conversely. In the model it is assumed that people start reacting against contracting a disease with self-protective measures whenever they are informed about the disease and when the burden of the disease is in a recognizable stage. It is shown that increasing the average effectiveness of self-protective measures is more important in decreasing the prevalence of a disease than increasing the proportion of individuals in a population into which awareness is created.

A sex-role-preference model for HIV transmission among men who have sex with men in China

Background

Men who have sex with men (MSM) are much more likely to be infected with HIV than the general population. China has a sizable population of MSM, including gay, bisexual men, money boys and some rural workers. So reducing HIV infection in this population is an important component of the national HIV/AIDS prevention and control program.

Methods

We develop a mathematical model using a sex-role-preference framework to predict HIV infection in the MSM population and to evaluate different intervention strategies.

Results

An analytic formula for the basic reproduction ratio R₀ was obtained; this yields R₀ = 3.9296 in the current situation, so HIV will spread very fast in the MSM population if no intervention measure is implemented in a timely fashion. The persistence of HIV infection and the existence of disease equilibrium (or equilibria) are also shown. We utilized our model to simulate possible outcomes of antiretroviral therapy and vaccination for the MSM population. We compared the effects of these intervention measures under different assumptions about MSM behaviour. We also found that R₀ is a decreasing function of the death rate of HIV-infected individuals, following a power law at least asymptotically.

Conclusion

HIV will spread very fast in the MSM population unless intervention measures are implemented urgently. Antiretroviral therapy can have substantial impact on the reduction of HIV among the MSM population, even if disinhibition is considered. The effect of protected sexual behaviour on controlling the epidemic in the MSM population largely depends on the sex-ratio preference of different sub-populations.

Modeling the population level effects of an HIV-1 vaccine in an era of highly active antiretroviral therapy

First generation HIV vaccines may have limited ability to prevent infection. Instead, they may delay the onset of AIDS or reduce the infectiousness of vaccinated individuals who become infected. To assess the population level effects of such a vaccine, we formulate a deterministic model for the spread of HIV in a homosexual population in which the use of highly active antiretroviral therapy (HAART) to treat HIV infection is incorporated. The basic reproduction number R(0) is obtained under this model. We then expand the model to include the potential effects of a prophylactic HIV vaccine. The reproduction number R(f) is derived for a population in which a fraction f of susceptible individuals is vaccinated and continues to benefit from vaccination. We define f(*) as the minimum vaccination fraction for which R(f )< or =1 and describe situations in which it equals the critical vaccination fraction necessary to eliminate disease. When R(0) is large or an HIV vaccine is only partially effective, the critical vaccination fraction may exceed one. HIV vaccination, however, may still reduce the prevalence of disease if the reduction in infectiousness is at least as great as the reduction in the rate of disease progression. In particular, a vaccine that reduces infectiousness during acute infection may have an important public health impact especially if coupled with counseling to reduce risky behavior.

Effects of public health educational campaigns and the role of sex workers on the spread of HIV/AIDS among heterosexuals

This paper presents a sex-structured model for heterosexual transmission of HIV/AIDS in which the population is divided into three subgroups: susceptibles, infectives and AIDS cases. The subgroups are further divided into two classes, consisting of individuals involved in high-risk sexual activities and individuals involved in low-risk sexual activities. The model considers the movement of individuals from high to low sexual activity groups as a result of public health educational campaigns. Thus, in this case public health educational campaigns are resulting in the split of the population into risk groups. The equilibrium and epidemic threshold, which is known as the basic reproductive number (R0), are obtained, and stability (local and global) of the disease-free equilibrium is investigated. The model is extended to incorporate sex workers, and their role in the spread of HIV/AIDS in settings with heterosexual transmission is explored. Comprehensive analytic and numerical techniques are employed in assessing the possible community benefits of public health educational campaigns in controlling HIV/AIDS. From the study, we conclude that the presence of sex workers enlarges the epidemic threshold R0, thus fuels the epidemic among the heterosexuals, and that public health educational campaigns among the high-risk heterosexual population reduces R0, thus can help slow or eradicate the epidemic.

Biological and demographic causes of high HIV and sexually transmitted disease prevalence in men who have sex with men

OBJECTIVES

HIV disproportionately affects men who have sex with men (MSM). MSM and heterosexual networks are distinguished by biologically determined sexual role segregation among heterosexual individuals but not MSM, and anal/vaginal transmissibility differences. To identify how much these biological and demographic differences could explain persistent disparities in HIV/sexually transmitted disease prevalence in the United States, even were MSM and heterosexual individuals to report identical numbers of unprotected sexual partnerships per year.

METHODS

A compartmental model parameterized using two population-based surveys. Role composition was varied between MSM and heterosexual subjects (insertive-only and receptive-only versus versatile individuals) and infectivity values.

RESULTS

The absence of sexual role segregation in MSM and the differential anal/vaginal transmission probabilities led to considerable disparities in equilibrium prevalence. The US heterosexual population would only experience an epidemic comparable to MSM if the mean partner number of heterosexual individuals was increased several fold over that observed in population-based studies of either group. In order for MSM to eliminate the HIV epidemic, they would need to develop rates of unprotected sex lower than those currently exhibited by heterosexual individuals in the United States. In this model, for US heterosexual individuals to have a self-sustaining epidemic, they would need to adopt levels of unprotected sex higher than those currently exhibited by US MSM.

CONCLUSIONS

The persistence of disparities in HIV between heterosexual individuals and MSM in the United States cannot be explained solely by differences in risky sexual behavior between these two populations.

Mathematical Study of a Staged-Progression HIV Model with Imperfect Vaccine

A staged-progression HIV model is formulated and used to investigate the potential impact of an imperfect vaccine. The vaccine is assumed to have several desirable characteristics such as protecting against infection, causing bypass of the primary infection stage, and offering a disease-altering therapeutic effect (so that the vaccine induces reversal from the full blown AIDS stage to the asymptomatic stage). The model, which incorporates HIV transmission by individuals in the AIDS stage, is rigorously analyzed to gain insight into its qualitative features. Using a comparison theorem, the model with mass action incidence is shown to have a globally-asymptotically stable disease-free equilibrium whenever a certain threshold, known as the vaccination reproduction number, is less than unity. Furthermore, the model with mass action incidence has a unique endemic equilibrium whenever this threshold exceeds unity. Using the Li-Muldowney techniques for a reduced version of the mass action model, this endemic equilibrium is shown to be globally-asymptotically stable, under certain parameter restrictions. The epidemiological implications of these results are that an imperfect vaccine can eliminate HIV in a given community if it can reduce the reproduction number to a value less than unity, but the disease will persist otherwise. Furthermore, a future HIV vaccine that induces the bypass of primary infection amongst vaccinated individuals (who become infected) would decrease HIV prevalence, whereas a vaccine with therapeutic effect could have a positive or negative effect at the community level.