HIV Sexual Transmission Is Predominantly Driven by Single Individuals Rather than Discordant Couples: A Model-Based Approach

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dc.creatorChampredon, Daviden
dc.creatorBellan, Steveen
dc.creatorDushoff, Jonathanen
dc.date.accessioned2014-12-15T17:10:35Zen
dc.date.available2014-12-15T17:10:35Zen
dc.date.issued2013-12-20en
dc.descriptionDavid Champredon, School of Computational Science and Engineering, McMaster University, Hamilton, Canadaen
dc.descriptionSteve Bellan, Center for Computational Biology and Bioinformatics, University of Texas at Austin, Austin, Texas, United States of Americaen
dc.descriptionJonathan Dushoff, Department of Biology, McMaster University, Hamilton, Canadaen
dc.description.abstractUnderstanding the relative contribution to HIV transmission from different social groups is important for public-health policy. Information about the importance of stable serodiscordant couples (when one partner is infected but not the other) relative to contacts outside of stable partnerships in spreading disease can aid in designing and targeting interventions. However, the overall importance of within-couple transmission, and the determinants and correlates of this importance, are not well understood. Here, we explore how mechanistic factors – like partnership dynamics and rates of extra-couple transmission – affect various routes of transmission, using a compartmental model with parameters based on estimates from Sub-Saharan Africa. Under our assumptions, when sampling model parameters within a realistic range, we find that infection of uncoupled individuals is usually the predominant route (median 0.62, 2.5%–97.5% quantiles: 0.26–0.88), while transmission within discordant couples is usually important, but rarely represents the majority of transmissions (median 0.33, 2.5%–97.5% quantiles: 0.10–0.67). We find a strong correlation between long-term HIV prevalence and the contact rate of uncoupled individuals, implying that this rate may be a key driver of HIV prevalence. For a given level of prevalence, we find a negative correlation between the proportion of discordant couples and the within-couple transmission rate, indicating that low discordance in a population may reflect a relatively high rate of within-couple transmission. Transmission within or outside couples and among uncoupled individuals are all likely to be important in sustaining heterosexual HIV transmission in Sub-Saharan Africa. Hence, intervention policies should be broadly targeted when practical.en
dc.description.catalogingnoteEmail: champrd@math.mcmaster.caen
dc.description.departmentCenter for Computational Biology and Bioinformaticsen
dc.description.sponsorshipDC and JD were supported by grants from the James S. McDonnell Foundation, the Canadian Institutes of Health Research, and the Canadian Natural Sciences and Engineering Research Council. SEB was supported by a National Institute of General Medical Sciences MIDAS grant U01GM087719 to Lauren A. Meyers and Alison P. Galvani. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.en
dc.identifier.Filenamejournal.pone.0082906.pdfen
dc.identifier.citationChampredon D, Bellan S, Dushoff J (2013) HIV Sexual Transmission Is Predominantly Driven by Single Individuals Rather than Discordant Couples: A Model-Based Approach. PLoS ONE 8(12): e82906. doi:10.1371/journal.pone.0082906en
dc.identifier.doiDOI: 10.1371/journal.pone.0082906en
dc.identifier.urihttp://hdl.handle.net/2152/27902en
dc.language.isoEnglishen
dc.publisherPLOS Oneen
dc.rightsAdministrative deposit of works to UT Digital Repository: This works author(s) is or was a University faculty member, student or staff member; this article is already available through open access at http://www.plosone.org. The public license is specified as CC-BY: http://creativecommons.org/licenses/by/4.0/. The library makes the deposit as a matter of fair use (for scholarly, educational, and research purposes), and to preserve the work and further secure public access to the works of the University.en
dc.subjectAfricaen
dc.subjectdeath ratesen
dc.subjectepidemiologyen
dc.subjectHIVen
dc.subjectHIV epidemiologyen
dc.subjectHIV infectionsen
dc.subjectSexually transmitted diseasesen
dc.subjectsimulation and modelingen
dc.titleHIV Sexual Transmission Is Predominantly Driven by Single Individuals Rather than Discordant Couples: A Model-Based Approachen
dc.typeArticleen

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