Implementing interventions targeted at discordant couples: a feasibility analysis for 14 African countries

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1 Implementing interventions targeted at discordant couples: a feasibility analysis for 14 African countries Brian J. Coburn and Sally Blower Center for Biomedical Modeling Semel Institute for Neuroscience & Human Behavior David Geffen School of Medicine at UCLA 7 th International Workshop on HIV Transmission: Principles of intervention July 2012, Washington, DC USA Funded by NIH/NIAID

2 Epidemic Control of SDC Interventions Are SDCs important in driving incidence? BJ Coburn, DJ Gerberry, & S Blower. Quantification of the role of discordant couples in driving incidence of HIV in sub-saharan Africa. Lancet Infect Dis 2011, 11: Would targeting SDCs for prevention have a significant impact? WM El-Sadr, BJ Coburn, & S Blower. Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission. AIDS 2011, 25: Are SDC interventions feasible? BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

3 Are SDCs important in driving incidence? BJ Coburn, DJ Gerberry, & S Blower. Quantification of the role of discordant couples in driving incidence of HIV in sub-saharan Africa. Lancet Infect Dis 2011, 11:

4 Would targeting SDCs for prevention have a significant impact? (HPTN 052) Lesotho, Malawi, Rwanda, Ghana Country-level incidence (per 1000 person-years) Annual number of infections prevented Treatment coverage in discordant couples Treatment coverage in discordant couples 70% is in stable partnerships WM El-Sadr, BJ Coburn, & S Blower. Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission. AIDS 2011, 25:

5 Are SDC interventions feasible? High (> 10%) Moderate (5-10%) Low (< 5%) BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

6 Locations of the 14 countries BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

7 Research Questions (i) Are HIV prevalence and the level of discordancy correlated? (i) What is the number per 1,000 individuals that are HIV-positive (HIV-negative) in SDC? (i) What is the percent of HIV-positive (HIVnegative) individuals are in SDC? Demographic & Health Survey data Mathematical modeling BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

8 (i) Are HIV prevalence and the level of discordancy correlated? y = A(e ax 1) + ε HIV Prevalence (%) HIV prevalence (y) level of discordancy (x) â = 0.13 (95% CI: 0.10, 0.17) Â = 4.37 (95% CI: 2.60, 7.57) Level of Discordancy (%) Error term (ε) BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

9 Utility: Unknown discordancy Inverse function: HIV Prevalence (%) x = 1 a log 1+ y A Example: HIV prevalence 10% discordancy ~9% Level of Discordancy (%) BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

10 (ii) What is the number per 1,000 individuals that are HIV-positive in SDC? Prevalence? Singles Couples Country-level Prevalence (from data) DHS Data Set

11 (ii) What is the number per 1,000 individuals that are HIV-positive in SDC? per 1000 individuals in SDCs per 1000 individuals in SDCs 3-19 per 1000 individuals in SDCs HIV-negative in SDC? BJ Coburn & S Blower. A feasibility analysis of implementing interventions for discordant couples in 14 African countries: implications for epidemic control. AIDS [in press]

12 (iii) What is the percent of HIV-positive (HIVnegative) individuals are in SDC? HIV-positive individuals (> 10%) 20-27% serodiscordant couples 40-58% concordant couples 22-33% single HIV-negative individuals (all countries) < 6% serodiscordant couples

13 Implications for Epidemic Control Interventions PrEP (ineffective SDCs) Singles TasP (effective SDCs) Feasibility (TasP) >10%, possible (challenging) <5%, unlikely

14 Thank you for listening Questions