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. 2015 Jun 3;10(6):e0126893.
doi: 10.1371/journal.pone.0126893. eCollection 2015.

Evaluating the Impact of Test-and-Treat on the HIV Epidemic among MSM in China Using a Mathematical Model

Sitong Luo  1 , Litao Han  2 , Hongyan Lu  3 , Zhi Dou  4 , Qian Tao  2 , Kaveh Khoshnood  5 , Zunyou Wu  4 , Jie Xu  4
Affiliations

Evaluating the Impact of Test-and-Treat on the HIV Epidemic among MSM in China Using a Mathematical Model

Sitong Luo et al. PLoS One. .

Abstract

Background: Various studies have modeled the impact of test-and-treat policies on the HIV epidemics worldwide. However, few modeling studies have taken into account China's context. To understand the potential effect of test-and-treat on the HIV epidemic among men who have sex with men (MSM) in China, we developed a mathematical model to evaluate the impact of the strategy.

Method: Based on the natural history of the CD4 count of people living with HIV and AIDS (PLWHA), we constructed a dynamic compartmental model of HIV transmission among Chinese MSM to project the number of HIV new infections and prevalence over 10 years. We predicted the annual number of HIV new infections and the total number of MSM living with HIV and AIDS (based on Beijing data) between 2010 and 2022 under the following conditions: (1) current practice (testing rate of 50% and ART coverage of 39%); (2) both testing rate and ART coverage increasing to 70% in 2013; (3) both testing rate and ART coverage increasing to 90% in 2013; and (4) both testing rate and ART coverage increasing gradually every year until 90% since 2013.

Results: Based on our model, if the HIV test-and-treat policy was implemented among Chinese MSM, the total number of HIV new infections over 10 years (2013-2022) would be reduced by 50.6-70.9% compared with the current policy. When ART coverage for PLWHA increased to 58% since 2013, the 'turning point' would occur on the curve of HIV new infections by 2015. A 25% reduction in annual number of HIV new infections by 2015 might be achieved if the testing rate increased from 50% to 70% and treatment coverage for PLWHA increased to 55% since 2013.

Conclusion: Implementation of the test-and-treat strategy may significantly reduce HIV new infections among MSM in China. Great efforts need to be made to scale up HIV testing rate and ART coverage among Chinese MSM.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Dynamic compartmental model for HIV transmission among Chinese MSM.
B represents the rate at which MSM enter into the HIV susceptible class (S). MSM infect HIV at a rate of ω, progress through four stages of HIV infection (I1-I4) at a corresponding rate ρi (i = 1–4), and then die of HIV/AIDS (D). μ1 represents the rate at which MSM leave the model for having no more same-sex behaviors or non-HIV related death. HIV positive MSM in each stage of HIV infection, excluding the acute stage (I1), are tested and put on ART at a corresponding rate τi (i = 2–4). After they receive ART, they may exit the model at a rate of μi (i = 2–4) for having no more same-sex behaviors or death. They may also stop treatment or the treatment may fail, in which case they return to the corresponding non-ART state at a rate φi (i = 2–4).
Fig 2
Fig 2. Number of HIV new infections among MSM, Beijing, 2010–2022.
Fig 3
Fig 3. Number of MSM living with HIV/AIDS, Beijing, 2010–2022.
See this image and copyright information in PMC

References

    1. Wang L. AIDS. Beijing: Beijing Publishing House; 2009. pp. 34.
    1. Office of the State Council Working Committee to Combat AIDS in China, UNAIDS Task Force in China. Estimates for the HIV/AIDS Epidemic in China. Beijing: Tsinghua University Press; 2007. pp. 8.
    1. Ministry of Health of the People’s Republic of China, UNAIDS, WHO. Estimates for the HIV/AIDS Epidemic in China. Beijing: Chinese Center for Diseases Control and Prevention Press; 2009. pp. 7.
    1. Ministry of Health of the People’s Republic of China, UNAIDS, WHO. Estimates for the HIV/AIDS Epidemic in China. Beijing: Chinese Center for Diseases Control and Prevention Press; 2011. pp. 5 10.3967/0895-3988.2011.04.004 - DOI
    1. UNAIDS. World AIDS Day Report 2012. Geneva: UNAIDS; 2012. pp. 43.

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