ArticlePloS one2013
Understanding the potential impact of a combination HIV prevention intervention in a hyper-endemic community.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Effects of community-based antiretroviral therapy initiation models on HIV treatment outcomes: A systematic review and meta-analysis.PLoS medicine · 2021Pooled it
- Trial
- Evaluating the biomedical and behavioral drivers of HIV incidence decline in adolescent girls and young women in Uganda: A mathematical modeling study.PLoS medicine · 2026Article
- Z-DEA-FMEA: identifying effective strategies for optimizing the HIV drugs supply chain using multi-criteria decision-making approaches.Frontiers in public health · 2025Article
- Who is Exposed to HIV Prevention Interventions? An Assessment of Associated Factors Among Adolescent Girls and Young Women in South Africa.AIDS and behavior · 2023Article
- A review of network simulation models of hepatitis C virus and HIV among people who inject drugs.The International journal on drug policy · 2021Review
- Phylogeography of HIV-1 suggests that Ugandan fishing communities are a sink for, not a source of, virus from general populations.Scientific reports · 2019Article
- Using mHealth to Deliver a Home-Based Testing and Counseling Program to Improve Linkage to Care and ART Adherence in Rural South Africa.Prevention science : the official journal of the Society for Prevention Research · 2019Article
- Epidemiology at a time for unity.International journal of epidemiology · 2018Article
- Completion of the tuberculosis care cascade in a community-based HIV linkage-to-care study in South Africa and Uganda.Journal of the International AIDS Society · 2018Article
- HIV Prevention Efforts and Incidence of HIV in Uganda.The New England journal of medicine · 2017Article
- High prevalence of HIV and non-communicable disease (NCD) risk factors in rural KwaZulu-Natal, South Africa.Journal of the International AIDS Society · 2017Article
- Combined interventions to reduce HIV incidence in KwaZulu-Natal: a modelling study.BMC infectious diseases · 2017Article
- Factors associated with changes in uptake of HIV testing among young women (aged 15-24) in Tanzania from 2003 to 2012.Infectious diseases of poverty · 2016Article
- Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya: a modelling study.BMC infectious diseases · 2016Article
- Estimating the impact of universal antiretroviral therapy for HIV serodiscordant couples through home HIV testing: insights from mathematical models.Journal of the International AIDS Society · 2016Article
- Current issues in the design and analysis of stepped wedge trials.Contemporary clinical trials · 2015Review
- Cost-effectiveness of community-based strategies to strengthen the continuum of HIV care in rural South Africa: a health economic modelling analysis.The lancet. HIV · 2015Article
- Estimation and Short-Term Prediction of the Course of the HIV Epidemic Using Demographic and Health Survey Methodology-Like Data.PloS one · 2015Article
- Combination HIV prevention interventions: the potential of integrated behavioral and biomedical approaches.Current HIV/AIDS reports · 2014Review
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
Abstract
objectivesDespite demonstrating only partial efficacy in preventing new infections, available HIV prevention interventions could offer a powerful strategy when combined. In anticipation of combination HIV prevention programs and research studies we estimated the population-level impact of combining effective scalable interventions at high population coverage, determined the factors that influence this impact, and estimated the synergy between the components.
methodsWe used a mathematical model to investigate the effect on HIV incidence of a combination HIV prevention intervention comprised of high coverage of HIV testing and counselling, risk reduction following HIV diagnosis, male circumcision for HIV-uninfected men, and antiretroviral therapy (ART) for HIV-infected persons. The model was calibrated to data for KwaZulu-Natal, South Africa, where adult HIV prevalence is approximately 23%.
resultsCompared to current levels of HIV testing, circumcision, and ART, the combined intervention with ART initiation according to current guidelines could reduce HIV incidence by 47%, from 2.3 new infections per 100 person-years (pyar) to 1.2 per 100 pyar within 4 years and by almost 60%, to 1 per 100 pyar, after 25 years. Short-term impact is driven primarily by uptake of testing and reductions in risk behaviour following testing while long-term effects are driven by periodic HIV testing and retention in ART programs. If the combination prevention program incorporated HIV treatment upon diagnosis, incidence could be reduced by 63% after 4 years and by 76% (to about 0.5 per 100 pyar) after 15 years. The full impact of the combination interventions accrues over 10-15 years. Synergy is demonstrated between the intervention components.
conclusionHigh coverage combination of evidence-based strategies could generate substantial reductions in population HIV incidence in an African generalized HIV epidemic setting. The full impact could be underestimated by the short assessment duration of typical evaluations.
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