%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Blaizot, S.
%A Maman, D.
%A Riche, B.
%A Mukui, I.
%A Kirubi, B.
%A Ecochard, R.
%A Etard, Jean-François
%T Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya : a modelling study
%D 2016
%L fdi:010066834
%G ENG
%J BMC Infectious Diseases
%@ 1471-2334
%K HIV ; Hyperendemic settings ; Mathematical models ; Antiretroviral therapy ; Male circumcision ; Pre-exposure prophylaxis
%K KENYA
%M ISI:000375080700001
%P art. 189 [10 ]
%R 10.1186/s12879-016-1520-4
%U https://www.documentation.ird.fr/hor/fdi:010066834
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers16-05/010066834.pdf
%V 16
%W Horizon (IRD)
%X Background: Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya). Methods: A mathematical model was used with data on adults (15-59 years) from the Ndhiwa HIV Impact in Population Survey to compare the impacts on HIV prevalence, HIV incidence rate, and population viral load suppression of various interventions. These interventions included: improving the cascade of care (use of three guidelines), increasing voluntary medical male circumcision (VMMC), and implementing pre-exposure prophylaxis (PrEP) use among HIV-uninfected women. Results: After four years, improving separately the cascade of care under the WHO 2013 guidelines and under the treat-all strategy would reduce the overall HIV incidence rate by 46 and 58 %, respectively, vs. the baseline rate, and by 35 and 49 %, respectively, vs. the implementation of the current Kenyan guidelines. With conservative and optimistic scenarios, VMMC and PrEP would reduce the HIV incidence rate by 15-25 % and 22-28 % vs. the baseline, respectively. Combining the WHO 2013 guidelines with VMMC would reduce the HIV incidence rate by 35-56 % and combining the treat-all strategy with VMMC would reduce it by 49-65 %. Combining the WHO 2013 guidelines, VMMC, and PrEP would reduce the HIV incidence rate by 46-67 %. Conclusions: The impacts of the WHO 2013 guidelines and the treat-all strategy were relatively close; their implementation is desirable to reduce HIV spread. Combining several strategies is promising in adult populations of hyperendemic areas but requires regular, reliable, and costly monitoring.
%$ 052 ; 056 ; 020