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
| dc.contributor.advisor | Nyasulu, Peter | en_ZA |
| dc.contributor.advisor | Kajungu, Dan | en_ZA |
| dc.contributor.author | Chibawara, Trust | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics. | en_ZA |
| dc.date.accessioned | 2022-01-10T13:44:48Z | |
| dc.date.accessioned | 2022-04-29T12:56:21Z | |
| dc.date.available | 2022-01-10T13:44:48Z | |
| dc.date.available | 2022-04-29T12:56:21Z | |
| dc.date.issued | 2021-04 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | 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 Results: The results of the systematic review showed that globally, there was no published or unpublished research found on the impact of the use of ART by HIV positive adults on HIV incidence in adolescent girls and young women.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. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Inleiding: Die bekendstelling van antiretrovirale middels het mense wat met MIV (PLHIV) leef, in staat gestel om 'n baie beter prognose te he. As sodanig het die gebruik van antiretrovirale middels gelei tot die afname in wereldwye MIV-voorkoms oor die afgelope dekade. Alhoewel hierdie prestasie belangrik is, is die rol van die wydverspreide gebruik van antiretrovirale middels op die MIV-epidemie onder adolessente meisies en jong vroue steeds onbekend. Hierdie studie het ten doel gehad om die impak van Vroee Toegang vir alle MIV-positiewe Volwassenes tot Antiretrovirale (EAAA) op MIV-voorkoms onder adolessente meisies en jong vroue in Eswatini te evalueer. Metodes: Om ons navorsingsdoelwitte te bereik, het hierdie navorsing uitgebreide wiskundige konsepte verskaf wat multidissipliner van aard is en het bewysgebaseerde sistematiese oorsig, statistiek, datawetenskap en openbare gesondheidsbenaderings ingesluit. Voorkeurverslagitems vir sistematiese resensies en meta-analise (PRISMA) riglyne is vir die sistematiese oorsig gebruik. Met behulp van Simpact, 'n individu-gebaseerde, gebeurtenisgedrewe, stogastiese simulasie-instrument, is 'n spesiaal ontwerpte MIV-oordragmodel aangeneem om die heteroseksuele oordrag van MIV in Eswatini te simuleer. Die toepassing van 'n vereenvoudigde modelkalibrasiebenadering het kliniese, biologiese en gedragsaanwysers van die Eswatini-implementeringsstudie genaamd "Maksimering van antiretrovirale behandeling vir beter gesondheid en nul nuwe MIV-infeksie: vroee toegang tot antiretrovirale behandeling vir almal (MaxART EAAA)" en Eswatini demografiese gekombineerde opsommende statistieke om die impak van EAAA op MIV-voorkoms by adolessente meisies en jong vroue af te lei. Resultate: Die resultate van die sistematiese oorsig het getoon dat daar wereldwyd geen gepubliseerde of ongepubliseerde navorsing gevind is oor die impak van die gebruik van ART deur MIV-positiewe volwassenes op MIV-voorkoms by adolessente meisies en jong vroue nie. aan die ander kant het ons model, wat daarop gemik was om die impak van EAAA op ouer mans van 18 jaar en ouer in Eswatini te evalueer, 'n vermindering van 45% (95% CI: 37–55) met een MIV-voorkoms onder die adolesse nte meisies en jong vroue van 15-24 jaar teenoor CD4 teldrempel vir ART-geskiktheid (standaard van sorg). Verder het gesimuleerde data getoon dat vroee toegang tot ART 'n soortgelyke impak gehad het van 47% (95% CI: 33–59) vermindering in MIV-voorkoms onder jonger mans van dieselfde ouderdomsgroep. Konklusie: Hierdie studie het die impak van EAAA getoon as 'n strategie om nuwe MIV-infeksies onder adolessente en jong vroue tussen 15-24 jaar in die Eswatini-bevolking te verminder. Hierdie bevindings versterk die behoefte om bepalings vir vroee aanvang van ART-behandeling onder MIV-geinfekteerde volwassenes aan te neem as 'n katalisator om die oordrag van MIV na die adolessente bevolking te verminder. Data uit hierdie studie beklemtoon ook die noodsaaklikheid van ander lande in die streek wat voor soortgelyke uitdagings te staan kom om 'n hoe MIV-voorkoms te he, om EAAA aan te neem, aangesien dit 'n effektiewe benadering is om die voorkoms van MIV/VIGS in die bevolking te verminder. alhoewel hierdie voordele applaud kan wees, besef ons dat die behandeling van MIV/VIGS nie voldoende is nie; daarom moet gedragsveranderings versterk word wat teen ouderdomsverskeie verhoudings beskerm. | af_ZA |
| dc.description.version | Doctorate | |
| dc.embargo.terms | 2022-07-10 | |
| dc.format.extent | xxi, 152 pages : illustrations, maps, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/125154 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject.lcsh | AIDS (Disease) in adolescence -- Eswatini | en_ZA |
| dc.subject.lcsh | Teenage girls -- Sexual behavior -- Eswatini | en_ZA |
| dc.subject.lcsh | Teenage girls -- Diseases -- Eswatini | en_ZA |
| dc.subject.lcsh | HIV infections -- Antiretroviral therapy (ART) -- Eswatini | en_ZA |
| dc.subject.lcsh | HIV (Viruses) -- Young adults -- Eswatini | en_ZA |
| dc.subject.name | UCTD | |
| dc.title | 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 | en_ZA |
| dc.type | Thesis | en_ZA |