Dobromir T Dimitrov, Benoit Masse, Marie-Claude Boily
{"title":"Who will Benefit from a Wide-Scale Introduction of Vaginal Microbicides in Developing Countries?","authors":"Dobromir T Dimitrov, Benoit Masse, Marie-Claude Boily","doi":"10.2202/1948-4690.1012","DOIUrl":"https://doi.org/10.2202/1948-4690.1012","url":null,"abstract":"<p><p>Vaginal microbicides (VMB) are currently among the few biomedical interventions designed to help women reduce their risk of acquiring HIV infection. However, the microbicide containing antiretroviral (ARV-VMB) may lead to the development of antiretroviral resistance and could paradoxically become more beneficial to men at the population level. We developed a mathematical model to study the impact of a wide-scale population usage of VMB in a heterosexual population. Gender ratios of prevented infections and prevalence reduction are evaluated in 63 different intervention schedules including continuous and interrupted ARV-VMB use by HIV-positive women. The influence of different factors on population-level benefits is also studied through Monte Carlo simulations using parameters sampled from primary ranges representative of developing countries. Our analysis indicates that women are more likely than men to benefit from ARV-VMB use since 78-80% of the total 63,000 simulations investigated (under different parameter sets) showed a female advantage whether benefit is measured as cumulative number of infections prevented, the percentage of cumulative infections prevented, or the expected reduction in prevalence. Stratified analysis by scenarios indicates that the likelihood of a male advantage with respect to the fractions of prevented infections varies from 6% to 49% among the scenarios. It is substantial only if the risk of systemic absorption and development of resistance to ARV-VMB is high and the HIV-positive women use VMB indefinitely without interruption. Therefore, the use of ARV-VMB, with successful control measures restricting usage by HIV-positive women, is still very much a female prevention tool.</p>","PeriodicalId":74867,"journal":{"name":"Statistical communications in infectious diseases","volume":"2 1","pages":"1012"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2202/1948-4690.1012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32085452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infectious Disease Modeling: Creating a Community to Respond to Biological Threats","authors":"J. Kaufman, S. Edlund, Judith V. Douglas","doi":"10.2202/1948-4690.1001","DOIUrl":"https://doi.org/10.2202/1948-4690.1001","url":null,"abstract":"The rise of global economies in the 21st century, the rapid national and international movement of people, and the increased reliance of developed countries on global trade, all greatly increase the potential and possible magnitude of a worldwide pandemic. New epidemics may be the result of global climate change, vector-borne diseases, food-borne illness, new naturally occurring pathogens, or bio-terrorist attacks. The threat is most severe for highly communicable diseases. When rapidly spreading microparasitic infections coincide with the rapid transportation, propagation, and dissemination of the pathogens and vectors for infection, the risks associated with emerging infectious disease increase. We discuss the use of publicly-available technologies in assisting public health officials and scientists in protecting populations from emerging disease or in implementing improved response measures. We illustrate possibilities using the SpatioTemporal Epidemiological Modeler (STEM) that was developed to run on the Open Health Framework (OHF) created by the Eclipse Foundation in 2004. An illustration regarding the spread of the influenza H1N1 virus from Mexico to the United States via air travel in Spring 2009 is briefly discussed.","PeriodicalId":74867,"journal":{"name":"Statistical communications in infectious diseases","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2009-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89063806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}