Online Program

Estimating the impact of combined prevention interventions targeting 15-24 years-old men and women in nyanza, Kenya

Monday, November 4, 2013

Ramzi Alsallaq, PhD, College of Nursing Golbal, New York University, New York, NY
Jasmine Buttolph, MPH, New York University, New York, NY
Charles M Cleland, PhD, NYU College of Nursing, New York University, New York City, NY
Timothy Hallett, Imperial College, London, United Kingdom
Ann Kurth, PhD, CNM, FAAN, NYU College of Nursing, New York University, New York City, NY
Background: Young males (YM) and especially young females (YF) (age 15-24) in sub-Saharan Africa are at a higher risk of HIV infection compared to older adults. HIV testing of young individuals facilitates early identification of their ‘HIV+' status, prompt ART initiation, and provision of male circumcision and PrEP. We hypothesize that youth-prioritized combination interventions could have substantial impact on HIV incidence among them and the wider adult population. Methods: Using an age-sex-risk stratified mathematical model representing HIV heterosexual transmission in Nyanza, Kenya, we estimated the impact of leveraging HIV testing and counseling among Nyanza youth, prompt ART initiation (at CD4<=50 cells/mm3) based on knowledge of status, and further gender-specific intervention components: male circumcision for YM and reduction of partners and PrEP for YF. Results: We predict a reduction in HIV incidence over 10 years among youth by 34% (from 1.6% /person-years) and adults by 29% (from 1.3% /person-years), if the annual testing likelihood for youth increases to 90% (from 13%) with newly HIV-diagnosed youth increasing condom use by 30% and initiating ART promptly. The adult incidence is reduced 41% and 37% by further male and female specific interventions. The full combination package would decrease incidence by 60% and 48% among youth and adults; respectively. Conclusions: In populations where young people are at the highest risk of HIV infection, carefully prioritized, gender-specific intervention can have a substantial impact on the risk of infection, both in that group and the population overall.

Learning Areas:

Other professions or practice related to public health

Learning Objectives:
Define combination interventions against HIV Identify gender-specific prevention interventions against HIV Compare HIV incidence with and without the interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an associate research scientist in global health and the project manager on the MP3 Youth pilot study. I have worked closely with the mathematical modeler to identify the intervention components, assumptions, and impact of the MP3 Youth mathematical model. I have previously worked as an epidemiological researcher in the Virgin Islands and a Technical Adviser for sexual health research in Morocco and Cairo.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.