Research Objectives

•          To understand the impact of the social environment on behavioral outcomes related to HIV transmission and ART uptake in KwaZulu-Natal, South Africa

•          To understand the impact of the current ART program in KwaZulu-Natal, different ART scenarios and additional preventive measures on HIV epidemic dynamics

•          To estimate the impact, cost and cost-effectiveness of the current ART program and additional preventive measures in KZN, South Africa

Rationale
While the individual-level effects of ART are well known, the impact of ART on HIV epidemic dynamics remains poorly understood. Although reduced infectivity of people on ART should lower HIV incidence, this could be counterbalanced by the longer duration of exposure due to the increased survival of people on Art.  Our aim is to develop a scientifically rigorous model linked to unique Africa Centre data to determine optimal HIV treatment and prevention strategies.

Fit In AC Agenda
This work is located within the HIV dynamics and understanding of the impact of ART roll-out on population level. As a predictive model it is closely aligned to the causal modelling undertaken in another project at the Centre, involving the same AC-based researchers.

Methods
We plan to use mathematical models, data already collected at the Africa Centre and a limited amount of primary data collection, to study the impact of ART on HIV epidemic dynamics.  The primary outcomes of interest include HIV prevalence and incidence, life expectancy, mortality and incidence of AIDS and intervention cost-effectiveness.  The STDSIM microsimulation model, initially developed to better understand the contrasting results of the Mwanza and Rakai sexually transmitted disease intervention trials, will be extended to include important aspects of HIV transmission, antiretroviral therapy, social environments and cost-effectiveness analysis.

Data Sources
We use data already collected in the ACDIS and ARTemis projects, as well as a limited amount of primary data collection to estimate the costs (from a patient and program perspective) of accessing HIV care and treatment in KwaZulu-Natal.

Preliminary Findings
This collaboration with Brown University in the US and the Erasmus Medical College in the Netherlands is funded by the US NIH (NIMH) and began in July 2009.  We are working on our first project paper, estimating the impact of the recent change in WHO HIV/AIDS treatment initiation guidelines.

Policy Implications
This project is strongly focused on identifying the optimal balance between treatment and prevention programs and as such will have significant policy implications. One component of the project, once much of the science is complete, is to convene policy makers to discuss the finding and their implications, and to clearly communicate our findings with policy makers.