Adapting Sexual Behavior Survey Data to Parameterize an Agent-Based Model of Human Papillomavirus (HPV) Transmission

PurposeSexual transmission of human papillomavirus (HPV) infection is important for capturing the indirect effects of interventions in mathematical models, but limited data create challenges for reflecting sexual behavior patterns over the lifespan of individuals and across heterogenous populations. We used nationally representative data from the United States to parameterize, calibrate, and validate a heterosexual transmission model of HPV.MethodsBased on sexual behavior data from the National Survey of Family Growth (2011-2019), we categorized respondents into 4 sexual activity categories, using their percentile of cumulative lifetime partners compared with others within their same sex and age group. We modeled probabilistic partnership acquisition and dissolution by age, sex, and sexual activity category. Partnership data were incorporated into an existing agent-based model of HPV transmission in the United States. We calibrated 1) per-partnership HPV transmission and 2) reduced risk of type-specific reinfection from natural immunity to fit age- and type-specific HPV prevalence using the National Health and Nutrition Examination Survey (NHANES 2002-2008). We validated the final model by comparing model-based projections of HPV prevalence against empirical data in the US population before and after widespread HPV vaccination.ResultsAfter calibrating to fit overall HPV prevalence, model validation exercises indicated that the distribution of prevaccine HPV prevalence across sexual activity categories closely matched NHANES estimates. Simulating vaccination rates over 10 y, the model replicated postvaccine NHANES data for prevalence of HPV16.ConclusionCapturing HPV transmission dynamics requires an understanding of sexual behavior across populations and over time. Defining sexual activity categories based on cumulative lifetime partners can capture patterns of HPV risk over a lifespan to reflect the dynamics of HPV transmission and vaccination.HighlightsUsing data from a large national survey, we developed sexual behavior inputs for an agent-based model of HPV transmission.We define 4 heterogenous risk groups using cumulative lifetime sexual behavior for males and females and find we can recreate validation data on both lifetime sexual patterns and age-specific HPV prevalence.Our calibrated model also reproduces early patterns of HPV reduction following HPV vaccine introduction.Modelers seeking to understand the long-term effects of the HPV vaccine should carefully consider the heterogeneity of sexual behavior across groups as well as changes in behavior over the lifespan.