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Elmes J, Silhol R, Hess KL, Gedge LM, Nordsletten A, Staunton R, Anton P, Shacklett B, McGowan I, Dang Q, Adimora AA, Dimitrov DT, Aral S, Handanagic S, Paz-Bailey G, Boily MC. Receptive anal sex contributes substantially to heterosexually acquired HIV infections among at-risk women in twenty US cities: Results from a modelling analysis. Am J Reprod Immunol 2020; 84:e13263. [PMID: 32384198 DOI: 10.1111/aji.13263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022] Open
Abstract
PROBLEM Receptive anal intercourse (RAI) is more efficient than receptive vaginal intercourse (RVI) at transmitting HIV, but its contribution to heterosexually acquired HIV infections among at-risk women in the USA is unclear. METHOD OF STUDY We analysed sexual behaviour data from surveys of 9152 low-income heterosexual women living in 20 cities with high rates of HIV conducted in 2010 and 2013 as part of US National HIV Behavioral Surveillance. We estimated RAI prevalence (past-year RAI) and RAI fraction (fraction of all sex acts (RVI and RAI) at the last sexual episode that were RAI among those reporting past-year RAI) overall and by key demographic characteristics. These results and HIV incidence were used to calibrate a risk equation model to estimate the population attributable fraction of new HIV infections due to RAI (PAFRAI ) accounting for uncertainty in parameter assumptions. RESULTS Receptive anal intercourse prevalence (overall: 32%, city range: 19%-60%) and RAI fraction (overall: 27%, city range: 18%-34%) were high overall and across cities, and positively associated with exchange sex. RAI accounted for an estimated 41% (uncertainty range: 18%-55%) of new infections overall (city range: 21%-57%). Variability in PAFRAI estimates was most influenced by uncertainty in the estimate of the per-act increased risk of RAI relative to RVI and the number of sex acts. CONCLUSION Receptive anal intercourse may contribute disproportionately to new heterosexually acquired HIV infections among at-risk low-income women in the USA, meaning that tools to prevent HIV transmission during RAI are warranted. The number of RVI and RAI acts should also be collected to monitor heterosexually acquired HIV infections.
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Affiliation(s)
- Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Kristen L Hess
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lukyn M Gedge
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Ashley Nordsletten
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Roisin Staunton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Peter Anton
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA
| | - Ian McGowan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Que Dang
- Vaccine Research Program, Division of AIDS, NIAID, Rockville, NIH, MD, USA
| | - Adaora A Adimora
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dobromir T Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sevgi Aral
- Division of Sexually Transmitted Disease Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,HPTN Modelling Centre, Imperial College London, London, UK
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Gedge LM, Bettis AA, Bradley MH, Hollingsworth TD, Turner HC. Economic evaluations of lymphatic filariasis interventions: a systematic review and research needs. Parasit Vectors 2018; 11:75. [PMID: 29391042 PMCID: PMC5793442 DOI: 10.1186/s13071-018-2616-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/02/2018] [Indexed: 01/13/2023] Open
Abstract
In 2000, the World Health Organization established the Global Programme to Eliminate Lymphatic Filariasis (GPELF), with the goal of eliminating the disease as a public health problem by 2020. Since the start of the programme, a cumulative total of 6.2 billion treatments have been delivered to affected populations - with more than 556 million people treated in 2015 alone. In this paper, we perform a rigorous systematic review of the economic evaluations of lymphatic filariasis interventions have been conducted. We demonstrate that the standard interventions to control lymphatic filariasis are consistently found to be highly cost-effective. This finding has important implications for advocacy groups and potential funders. However, there are several important inconsistencies and research gaps that need to be addressed as we move forward towards the 2020 elimination goals. One of the most important identified research gaps was a lack of evaluation of new interventions specifically targeting areas co-endemic with onchocerciasis and Loa loa - which could become a major barrier to achieving elimination.
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Affiliation(s)
- Lukyn M. Gedge
- School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London, W2 1PG UK
| | - Alison A. Bettis
- London Centre for Neglected Tropical Disease Research, London, UK
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London, W2 1PG UK
| | | | - T. Déirdre Hollingsworth
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL UK
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL UK
- Big Data Institute, University of Oxford, Oxford, OX3 7LF UK
| | - Hugo C. Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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