Evaluating HIV prevention strategies for populations in key affected groups: the example of Cabo Verde
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We used an individual-based model to evaluate the effects of hypothetical prevention interventions on HIV incidence trajectories in a concentrated, mixed epidemic setting from 2011 to 2021, and using Cabo Verde as an example.
Simulations were conducted to evaluate the extent to which early HIV treatment and optimization of care, HIV testing, condom distribution, and substance abuse treatment could eliminate new infections (i.e., reduce incidence to less than 10 cases per 10,000 person-years) among non-drug users, female sex workers (FSW), and people who use drugs (PWUD).
Scaling up all four interventions resulted in the largest decreases in HIV, with estimates ranging from 1.4 (95 % CI 1.36–1.44) per 10,000 person-years among non-drug users to 8.2 (95 % CI 7.8–8.6) per 10,000 person-years among PWUD in 2021. Intervention scenarios prioritizing FWS and PWUD also resulted in HIV incidence estimates at or below 10 per 10,000 person-years by 2021 for all population sub-groups.
Our results suggest that scaling up multiple interventions among entire population is necessary to achieve elimination. However, prioritizing key populations with this combination prevention strategy may also result in a substantial decrease in total incidence.
KeywordsIndividual-based model Condom use Female sex workers Monte Carlo simulation People who use drugs Substance use
The authors would like to thank Dr. Celso Herminio Soares Ribeiro at the Cabo Verde National Statistic Institute (INE-CV), for providing the technical reports and HIV/AIDS data in Cabo Verde. The authors also acknowledge the staff and resources provided by the Brown University Center for Computation & Visualization. We would like to thank Dr. Magdalena Paczkowski for assisting with the ABM python code adaptation to the Cabo Verde population. This research was supported, in part, by a T32 training grant from the National Institute on Drug Abuse awarded to the Miriam Hospital (T32-DA13911). This project is funded in part by the National Institutes of Health (R01-DA013336) as part of the Community Vulnerability and Responses to Drug-User Related HIV/AIDS (CVAR) study, and was also funded in part by a 2012 developmental grant from the Lifespan/Tufts/Brown Center for AIDS Research (P30-AI042853). Dr. Filipe Monteiro is supported by a postdoctoral fellowship, T32 Training Program in HIV and Other Consequences of Substance Abuse (grant number T32-DA013911). Dr. Brandon Marshall is supported by a Salomon Faculty Research Award from Brown University.
- Centers for Disease Control and Prevention (CDC) (2013) Differences between HIV-Infected men and women in antiretroviral therapy outcomes—six African countries, 2004–2012. MMWR Morb Mortal Wkly Rep 62(47):945–952Google Scholar
- Delgado APC, Carvalho IAS, Duarte IMS, Andrade VLG (2013) Relatório Estatístico 2012 [2012 Statistical Report]. Ministério da Saúde [Department of Health], Praia, República de Cabo Verde [Republic of Cabo Verde]Google Scholar
- DOHCV (2011) Relatório Estatístico 2010 [2010 Statistical Report]. Minstério da Saúde [Department of Health], Praia, República de Cabo Verde [Republic of Cabo Verde]Google Scholar
- DOHCV (2012) Relatório Estatístico 2011 [2011 Statistical Report]. Ministério da Saúde [Department of Health], Praia, República de Cabo Verde [Republic of Cabo Verde]Google Scholar
- Ekouevi DK, Coffie PA, Salou M et al (2013) HIV seroprevalence among drug users in Togo. Sante Publique 4:491–498Google Scholar
- INE, Ministério da Saúde, Macro International (2008) Segundo Inquérito Demográfico e de Saúde Reprodutiva, Cabo Verde, IDSR-II, 2005 [Second Demographic and Reproductive Health Survey, Cabo Verde, IDSR-II, 2005]. Instituto Nacional de Estatística de Cabo Verde (INE) [National Statistics Institute of Cabo Verde], Calverton, Maryland, USAGoogle Scholar
- INE (2010) IVº RECENSEAMENTO GERAL DA POPULAÇÃO E DE HABITAÇÃO—CENSO 2010 [IVth GENERAL CENSUS OF POPULATION AND HOUSING—2010 Census]. Instituto Nacional de Estatística de Cabo Verde (INE) [National Statistics Institute of Cabo Verde]. http://www.ine.cv. Accessed May 14, 2014
- Landovitz RJ, Fletcher JB, Inzhakova G, Lake JE, Shoptaw S, Reback CJ (2012) A novel combination HIV prevention strategy: post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine-using men who have sex with men. AIDS Patient Care STDS 26(6):320–328CrossRefPubMedCentralPubMedGoogle Scholar
- Lopes E Prevenção da Transmissão Vertical do VIH em Cabo Verde [Preventing HIV Vertical Transmission in Cabo Verde]. In: III Congresso da CPLP VIH/SIDA—IST [III CPLP Conference in HIV/AIDS—STD], Lisbon, Portugal, March 17-19 2010Google Scholar
- Mack N, Odhiambo J, Wong CM, Agot K (2014) Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: results of a consultation with community stakeholders. BMC Health Serv Res 14:231CrossRefPubMedCentralPubMedGoogle Scholar
- Monteiro ML, Sylva RC (2011) Estudo Socio-comportamental e de seroprevalência do VIH/SIDA nos usários de droga/usários de drogas injectável [Socio-behavioral and seroprevalence study of HIV/AIDS in drug users tand injecting drug users]. Minstério da Saúde [Department of Health], Praia, República de Cabo Verde [Republic of Cabo Verde]Google Scholar
- Sylva RC, Semedo E, Monteiro ML (2011) Cartografia e estudo socio-comportamental e de seroprevalência do VIH/SIDA nas profissionais do sexo [Cartography and socio-behavioral and seroprevalence of HIV/AIDS study among sex workers]. Minstério da Saúde [Department of Health], Praia, República de Cabo Verde [Republic of Cabo Verde]Google Scholar
- Tavares CM, Schor N, Valenti VE, Abreu LC (2012) Condom use at last sexual relationship among adolescents of Santiago Island, Cape Verde—West Africa. Reprod Health 9(29):PMC3538512Google Scholar
- UNAIDS (2012) Rapport d’activite sur la riposte au SIDA au Cap Vert [Progress report on the response to AIDS in Cabo Verde]. Comité de coordenação do combate à SIDA [Coordination Committee for the Fight Against AIDS], República de Cabo Verde [Republic of Cabo Verde]Google Scholar
- UNAIDS (2013) UNAIDS report on the global AIDS epidemic. WHO Library Cataloguing-in-Publication Data, Geneva, p 198Google Scholar
- WHO (2010) Antiretroviral therapy for HIV infection in adults and adolescents. WHO, GenevaGoogle Scholar