Doctoral Degrees (Epidemiology and Biostatistics)

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Browsing Doctoral Degrees (Epidemiology and Biostatistics) by browse.metadata.advisor "Nyasulu, Peter"

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    Model-based inference on the impact of early access to antiretroviral therapy to all on HIV incidence among adolescent girls and young women in Eswatini
    (Stellenbosch : Stellenbosch University, 2021-04) Chibawara, Trust; Nyasulu, Peter; Kajungu, Dan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY: Introduction: The introduction of antiretroviral drugs has enabled people living with HIV (PLHIV) to have a much better prognosis. As such, the use of antiretroviral drugs has resulted in the decline of global HIV incidence over the last decade. Whilst this achievement is important, the role of the widespread use of antiretroviral drugs on the HIV epidemic among adolescent girls and young women is still unknown. This study aimed to evaluate the impact of Early Access for all HIV-positive Adults to Antiretroviral (EAAA) on HIV incidence among adolescent girls and young women in Eswatini. Methods: To accomplish our research objectives, this research provided elaborate mathematical concepts that are multidisciplinary in nature and included evidence based systematic review, statistics, data science and public health approaches. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was used for the systematic review. Using Simpact, an individual-based, event-driven, stochastic simulation tool, a specially designed HIV transmission model was adopted to simulate the heterosexual transmission of HIV in Eswatini. The application of a simplified model calibration approach combined clinical, biological, and behavioural indicators from the Eswatini implementation study called “Maximizing Antiretroviral Treatment for Better Health and Zero New HIV Infection: Early Access to Antiretroviral Treatment for All (MaxART EAAA)” and Eswatini demographic summary statistics to infer the impact of EAAA on HIV incidence in adolescent girls and young women. Results: The results of the systematic review showed that globally, there was no published or unpublished research found on the impact of the use of ART by HIV positive adults on HIV incidence in adolescent girls and young women. While on the other hand, our model which aimed to evaluate the impact of EAAA on older men aged 18 years and above in Eswatini showed a 45% (95% Confidence interval (CI): 37-55) reduction on HIV incidence among the adolescent girls and young women aged 15-24-years-old as opposed to CD4 cell count threshold for ART eligibility (Standard of care). Furthermore, simulated data showed that early access to ART has a similar impact of 47% (95% CI: 33-59) reduction in HIV incidence among adolescent boys and young men of the same age group. Conclusion: This study has demonstrated the impact of EAAA as a strategy to reduce new HIV infections among adolescent girls and young women aged between 15-24-years-old in the Eswatini population. These findings reinforce the need to adopt provisions for early initiation of ART treatment among HIV infected adults as a catalyst to minimize transmission of HIV to the adolescent population. Data from this study also highlight the need for other countries in the region who are faced with similar challenges of harbouring a high HIV prevalence to adopt EAAA as it has shown to be an effective approach to reduce HIV/AIDS incidence in the population. While these benefits are applaudable, we do recognize that HIV/AIDS treatment on its on is not sufficient; therefore, behavioural changes that guard against age-disparate relationships should be reinforced.