Perceived risk induced multiscale model: Coupled within-host and between-host dynamics and behavioral dynamics

A novel multiscale model is formulated to examine the co-evolution among behavioral dynamics, disease transmission dynamics and viral dynamics, in which perceived risk act as a bridge for realizing the bidirectional coupling of between-host dynamics and within-host dynamics. The model is validated by real data and exhibits rich dynamic behaviors including the periodic oscillations of the solutions, the discordance of transmission dynamics and viral dynamics. It is observed that new infections may increase with improving treatment efficacy, which may reveal the hidden mechanisms why it is hard to eliminate HIV/AIDS infection only with the strategy of treatment. If increasing treatment efficacy but without improving diagnosis rate, "nearly elimination" phenomenon may happen when the risk threshold for behavior changes is low, in which the number of new infections may drop to a relatively low level but increase again to a relatively high level after a period of time as people may hardly keep their awareness and increase their high risk behaviors. The findings indicate that the intervention measures should be implemented both at individual level and population level to realize "ending the AIDS".