Objective To project the HIV/AIDS epidemics among men who have sex with men (MSM) under different combinations of HIV testing and linkage to care (TLC) interventions including antiretroviral therapy (ART) in Beijing, China. Design Mathematical modeling. Methods Using a mathematical model to fit prevalence estimates from 2000–2010, we projected trends in HIV prevalence and incidence during 2011–2020 under five scenarios: (S1) current intervention levels by averaging 2000–2010 coverage; (S2) increased ART coverage with current TLC; (S3) increased TLC/ART coverage; (S4) increased condom use; and (S5) increased TLC/ART plus increased condom use. Results The basic reproduction number based upon the current level of interventions is significantly higher than 1 ( confidence interval (CI), 1.83–2.35), suggesting that the HIV epidemic will continue to increase to 2020. Compared to the 2010 prevalence of 7.8%, the projected HIV prevalence in 2020 for the five prevention scenarios will be: (S1) Current coverage: 21.4% (95% CI, 9.9–31.7%); (S2) Increased ART: 19.9% (95% CI, 9.9–28.4%); (S3) Increased TLC/ART: 14.5% (95% CI, 7.0–23.8%); (S4) Increased condom use: 13.0% (95% CI, 9.8–28.4%); and (S5) Increased TLC/ART and condom use: 8.7% (95% CI, 5.4–11.5%). HIV epidemic will continue to rise () for S1–S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline () for S5. Conclusion Our transmission model suggests that Beijing MSM will have a rapidly rising HIV epidemic. Even enhanced levels of TLC/ART will not interrupt epidemic expansion, despite optimistic assumptions for coverage. Promoting condom use is a crucial component of combination interventions.
References
[1]
US Centers for Disease Control and Prevention (1981) Pneumocystis pneumonia–Los Angeles. MMWR Morbidity and mortality weekly report 30: 250–252.
[2]
Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, et al. (2012) Global epidemiology of HIV infection in men who have sex with men. Lancet 380: 367–377. doi: 10.1016/s0140-6736(12)60821-6
[3]
Ministry of Health in People's Republic of China, Joint United Nations Programme on HIV/AIDS, World Health Organization (2011) 2011 Estimates for the HIV/AIDS Epidemic in China. Beijing, China.
[4]
Wu Z, Xu J, Liu E, Mao Y, Xiao Y, et al.. (2013) HIV and Syphilis Prevalence Among Men Who Have Sex With Men: A Cross-Sectional Survey of 61 Cities in China. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
[5]
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG (2009) Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373: 48–57. doi: 10.1016/s0140-6736(08)61697-9
[6]
Vernazza PL, Gilliam BL, Flepp M, Dyer JR, Frank AC, et al. (1997) Effect of antiviral treatment on the shedding of HIV-1 in semen. AIDS 11: 1249–1254. doi: 10.1097/00002030-199710000-00008
[7]
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. The New England journal of medicine 365: 493–505. doi: 10.1056/nejmoa1105243
[8]
Lima VD, Johnston K, Hogg RS, Levy AR, Harrigan PR, et al. (2008) Expanded access to highly active antiretroviral therapy: a potentially powerful strategy to curb the growth of the HIV epidemic. J Infect Dis 198: 59–67. doi: 10.1086/588673
[9]
Cremin I, Alsallaq R, Dybul M, Piot P, Garnett G, et al. (2013) The new role of antiretrovirals in combination HIV prevention: a mathematical modelling analysis. Aids 27: 447–458. doi: 10.1097/qad.0b013e32835ca2dd
[10]
Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R (2007) Evolution of China's response to HIV/AIDS. Lancet 369: 679–690. doi: 10.1016/s0140-6736(07)60315-8
[11]
Qian HZ, Vermund SH, Kaslow RA, Coffey CS, Chamot E, et al. (2006) Co-infection with HIV and hepatitis C virus in former plasma/blood donors: challenge for patient care in rural China. Aids 20: 1429–1435. doi: 10.1097/01.aids.0000233577.33973.fa
[12]
Lu L, Jia M, Ma Y, Yang L, Chen Z, et al. (2008) The changing face of HIV in China. Nature 455: 609–611.
[13]
Zhang F, Dou Z, Ma Y, Zhang Y, Zhao Y, et al. (2011) Effect of earlier initiation of antiretroviral treatment and increased treatment coverage on HIV-related mortality in China: a national observational cohort study. The Lancet infectious diseases 11: 516–524. doi: 10.1016/s1473-3099(11)70097-4
[14]
Ye S, Xiao Y, Jin C, Cassell H, Blevins M, et al. (2012) Effectiveness of integrated HIV prevention interventions among Chinese men who have sex with men: evaluation of a 16-city public health program. PloS one 7: e50873. doi: 10.1371/journal.pone.0050873
[15]
Li HM, Peng RR, Li J, Yin YP, Wang B, et al. (2011) HIV incidence among men who have sex with men in China: a meta-analysis of published studies. PloS one 6: e23431. doi: 10.1371/journal.pone.0023431
[16]
Zhang L, Gray RT, Wilson DP (2012) Modelling the epidemiological impact of scaling up HIV testing and antiretroviral treatment in China. Sexual health 9: 261–271. doi: 10.1071/sh11104
[17]
Ahlgren DJ, Gorny MK, Stein AC (1990) Model-based optimization of infectivity parameters: a study of the early epidemic in San Francisco. Journal of acquired immune deficiency syndromes 3: 631–643.
[18]
Jacquez JA, Koopman JS, Simon CP, Longini IM Jr (1994) Role of the primary infection in epidemics of HIV infection in gay cohorts. Journal of acquired immune deficiency syndromes 7: 1169–1184. doi: 10.1097/00042560-199505010-00020
[19]
Tan WY, Xiang Z (1999) The state-space model of the HIV epidemic with variable infection in the homosexual populations. J Stat Plan Inference 78: 71–87. doi: 10.1016/s0378-3758(98)00207-9
[20]
Phillips AN, Cambiano V, Nakagawa F, Brown AE, Lampe F, et al. (2013) Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic. PloS one 8: e55312. doi: 10.1371/journal.pone.0055312
[21]
Wirtz AL, Walker DG, Bollinger L, Sifakis F, Baral S, et al. (2013) Modelling the impact of HIV prevention and treatment for men who have sex with men on HIV epidemic trajectories in low- and middle-income countries. International journal of STD & AIDS doi: 10.1177/0956462412472291
[22]
van Sighem A, Vidondo B, Glass TR, Bucher HC, Vernazza P, et al. (2012) Resurgence of HIV infection among men who have sex with men in Switzerland: mathematical modelling study. PloS one 7: e44819. doi: 10.1371/journal.pone.0044819
[23]
Wilson DP, Hoare A, Regan DG, Law MG (2009) Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sexual health 6: 19–33. doi: 10.1071/sh08081
[24]
Supervie V, Garcia-Lerma JG, Heneine W, Blower S (2010) HIV, transmitted drug resistance, and the paradox of preexposure prophylaxis. Proceedings of the National Academy of Sciences of the United States of America 107: 12381–12386. doi: 10.1073/pnas.1006061107
[25]
Muessig KE, Smith MK, Powers KA, Lo YR, Burns DN, et al. (2012) Does ART prevent HIV transmission among MSM? AIDS 26: 2267–2273. doi: 10.1097/qad.0b013e328355713d
[26]
Dodd PJ, Garnett GP, Hallett TB (2010) Examining the promise of HIV elimination by ‘test and treat’ in hyperendemic settings. AIDS 24: 729–735. doi: 10.1097/qad.0b013e32833433fe
[27]
Agusto FB, Gumel AB (2013) Qualitative dynamics of lowly- and highly-pathogenic avian influenza strains. Math Biosci 243: 147–162. doi: 10.1016/j.mbs.2013.02.001
[28]
Buonomo B, Vargas-De-Leon C (2012) Global stability for an HIV-1 infection model including an eclipse stage of infected cells. Journal of Mathematical Analysis and Applications 385: 709–720. doi: 10.1016/j.jmaa.2011.07.006
[29]
Wang JJ, Zhang JZ, Jin Z (2010) Analysis of an SIR model with bilinear incidence rate. Nonlinear Analysis-Real World Applications 11: 2390–2402. doi: 10.1016/j.nonrwa.2009.07.012
[30]
Baggaley RF, White RG, Boily MC (2010) HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol 39: 1048–1063. doi: 10.1093/ije/dyq057
[31]
Zhou ZH, Li SM, Liu YJ, Jiang SL, Zhang XX, et al. (2010) [Study on the relationship between behavioral factors, psychological status and HIV infection among men who have sex with men in Beijing.]. Zhonghua Liu Xing Bing Xue Za Zhi 31: 273–276.
[32]
Ruan Y, Luo F, Jia Y, Li X, Li Q, et al. (2009) Risk factors for syphilis and prevalence of HIV, hepatitis B and C among men who have sex with men in Beijing, China: implications for HIV prevention. AIDS Behav 13: 663–670. doi: 10.1007/s10461-008-9503-0
[33]
Xu J, Han DL, Liu Z, Ma XY, Wang LL, et al. (2010) [The prevalence of HIV infection and the risk factors among MSM in 4 cities, China]. Zhonghua Yu Fang Yi Xue Za Zhi 44: 975–980.
[34]
Chow EP, Wilson DP, Zhang L (2012) Patterns of condom use among men who have sex with men in China: a systematic review and meta-analysis. AIDS and Behavior 16: 653–663. doi: 10.1007/s10461-011-9935-9
[35]
Fan S, Lu H, Ma X, Sun Y, He X, et al. (2012) Behavioral and serologic survey of men who have sex with men in Beijing, China: implication for HIV intervention. AIDS Patient Care STDS 26: 148–155. doi: 10.1089/apc.2011.0277
[36]
Li D-l, Liang H-Y, Yang Y (2008) A Survey of Initial and Factors of Homosexual Intercourse Among Men Who Have Sex With Men. Journal of Preventive Medicine Information 6: 008.
[37]
Ma Y, Zhang F, Zhao Y, Zang C, Zhao D, et al. (2010) Cohort profile: the Chinese national free antiretroviral treatment cohort. International journal of epidemiology 39: 973–979. doi: 10.1093/ije/dyp233
[38]
R？ttingen J-A, Garnett GP (2002) The epidemiological and control implications of HIV transmission probabilities within partnerships. Sexually transmitted diseases 29: 818–827. doi: 10.1097/00007435-200212000-00014
[39]
Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM (2008) Relation between HIV viral load and infectiousness: a model-based analysis. The Lancet 372: 314–320. doi: 10.1016/s0140-6736(08)61115-0
[40]
Van den Driessche P, Watmough J (2002) Reproduction numbers and sub-threshold endemic equilibria for compartmental models of disease transmission. Mathematical biosciences 180: 29–48. doi: 10.1016/s0025-5564(02)00108-6
[41]
Liu H, Liu Y, Xiao Y (2001) A survey on knowledge, attitude, belief and practice related to HIV/AIDS among MSM. J China AIDS/STD Prevent Control 7: 289–291.
[42]
Haario H, Laine M, Mira A, Saksman E (2006) DRAM: efficient adaptive MCMC. Statistics and Computing 16: 339–354. doi: 10.1007/s11222-006-9438-0
[43]
Li X, Lu H, Raymond HF, Sun Y, Jia Y, et al. (2012) Untested and undiagnosed: barriers to HIV testing among men who have sex with men, Beijing, China. Sexually transmitted infections 88: 187–193. doi: 10.1136/sextrans-2011-050248
[44]
Qian HZ, Vermund SH, Wang N (2005) Risk of HIV/AIDS in China: subpopulations of special importance. Sex Transm Infect 81: 442–447. doi: 10.1136/sti.2004.014258
[45]
Vardavas R, Blower S (2007) The emergence of HIV transmitted resistance in Botswana:“when will the WHO detection threshold be exceeded?”. PLoS One 2: e152. doi: 10.1371/journal.pone.0000152
[46]
Johnson LF, Dorrington RE (2006) Modelling the demographic impact of HIV/AIDS in South Africa and the likely impact of interventions. Demographic Research 14: 541–574. doi: 10.4054/demres.2006.14.22
[47]
Yu M-R, Li S-M, Yan L (2011) HIV testing and its influence factors among men who have sex with men in Beijing. Chinese Journal of Public Health 10: 011.
[48]
Porco TC, Martin JN, Page-Shafer KA, Cheng A, Charlebois E, et al. (2004) Decline in HIV infectivity following the introduction of highly active antiretroviral therapy. AIDS (London, England) 18: 81. doi: 10.1097/00002030-200401020-00010
[49]
CDC C (2010) Annual Report on HIV/AIDS in Beijing.
[50]
Hoare A, Regan DG, Wilson DP (2008) Theoretical Biology and Medical Modelling. Theoretical Biology and Medical Modelling 5: 4. doi: 10.1186/1742-4682-5-4
[51]
Helton JC, Iman RL, Brown JB (1985) Sensitivity analysis of the asymptotic behavior of a model for the environmental movement of radionuclides. Ecological modelling 28: 243–278. doi: 10.1016/0304-3800(85)90077-8
[52]
Velasco-Hernandez JX, Gershengorn HB, Blower SM (2002) Could widespread use of combination antiretroviral therapy eradicate HIV epidemics? The Lancet infectious diseases 2: 487–493. doi: 10.1016/s1473-3099(02)00346-8
[53]
Tucker JD, Wong FY, Nehl EJ, Zhang F (2012) HIV testing and care systems focused on sexually transmitted HIV in China. Sexually transmitted infections 88: 116–119. doi: 10.1136/sextrans-2011-050135
[54]
Bunnell R, Ekwaru JP, Solberg P, Wamai N, Bikaako-Kajura W, et al. (2006) Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 20: 85–92. doi: 10.1097/01.aids.0000196566.40702.28
[55]
Del Romero J, Castilla J, Hernando V, Rodriguez C, Garcia S (2010) Combined antiretroviral treatment and heterosexual transmission of HIV-1: cross sectional and prospective cohort study. BMJ 340: c2205. doi: 10.1136/bmj.c2205
[56]
Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, et al. (2010) Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet 375: 2092–2098. doi: 10.1016/s0140-6736(10)60705-2
[57]
Sullivan P, Kayitenkore K, Chomba E, Karita E, Mwananyanda L, et al.. (2010) Reduction of HIV transmission risk while prescribed anti-retroviral therapy (ARVT): Misclassification of ARVT status as a methodological issue [abstract]. In: AIDS Res Hum Retroviruses, editor. AIDS Vaccine 2010; 28 Sept–1 Oct 2010. Atlanta, Georgia, US.
[58]
Wang L, Zeng G, Luo J, Duo S, Xing G, et al. (2010) HIV transmission risk among serodiscordant couples: a retrospective study of former plasma donors in Henan, China. J Acquir Immune Defic Syndr 55: 232–238. doi: 10.1097/qai.0b013e3181e9b6b7
[59]
Sullivan PS, Carballo-Dieguez A, Coates T, Goodreau SM, McGowan I, et al. (2012) Successes and challenges of HIV prevention in men who have sex with men. Lancet 380: 388–399. doi: 10.1016/s0140-6736(12)60955-6
[60]
Jia Z, Ruan Y, Li Q, Xie P, Li P, et al. (2012) Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study. Lancet doi: 10.1016/s0140-6736(12)61898-4
