Changing Risk Behaviours and the HIV Epidemic: A Mathematical Analysis in the Context of Treatment as Prevention

2013 | PloS One

Abstract:

Background

Expanding access to highly active antiretroviral therapy (HAART) has become an important approach to HIV prevention in recent years. Previous studies suggest that concomitant changes in risk behaviours may either help or hinder programs that use a Treatment as Prevention strategy.

Analysis

We consider HIV-related risk behaviour as a social contagion in a deterministic compartmental model, which treats risk behaviour and HIV infection as linked processes, where acquiring risk behaviour is a prerequisite for contracting HIV. The equilibrium behaviour of the model is analysed to determine epidemic outcomes under conditions of expanding HAART coverage along with risk behaviours that change with HAART coverage. We determined the potential impact of changes in risk behaviour on the outcomes of Treatment as Prevention strategies. Model results show that HIV incidence and prevalence decline only above threshold levels of HAART coverage, which depends strongly on risk behaviour parameter values. Expanding HAART coverage with simultaneous reduction in risk behaviour act synergistically to accelerate the drop in HIV incidence and prevalence. Above the thresholds, additional HAART coverage is always sufficient to reverse the impact of HAART optimism on incidence and prevalence. Applying the model to an HIV epidemic in Vancouver, Canada, showed no evidence of HAART optimism in that setting.

Conclusions

Our results suggest that Treatment as Prevention has significant potential for controlling the HIV epidemic once HAART coverage reaches a threshold. Furthermore, expanding HAART coverage combined with interventions targeting risk behaviours amplify the preventive impact, potentially driving the HIV epidemic to elimination.

Citation: Ramadanovic B, Vasarhelyi K, Nadaf A, Wittenberg RW, Montaner JSG, et al. (2013) Changing Risk Behaviours and the HIV Epidemic: A Mathematical Analysis in the Context of Treatment as Prevention. PLoS ONE 8(5): e62321. doi:10.1371/journal.pone.0062321

Editor: Edward White, Yale School of Public Health, United States of America

Received: August 9, 2012; Accepted: March 21, 2013; Published: May 6, 2013

Copyright: © 2013 Ramadanovic et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was supported by Canadian Institute of Health Research (http://www.cihr-irsc.gc.ca/e/193.html) grant number: 103129. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

BC Centre for Excellence in HIV/AIDS

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Changing Risk Behaviours and the HIV Epidemic: A Mathematical Analysis in the Context of Treatment as Prevention

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