测试悖论可能解释了在艾滋病毒prEP的MSM中观察到的细菌性传播感染的增加:一项建模研究
Laura Müller1,2, Piklu Mallick1,2, Antonio B Marín-Carballo1,3
1Max Planck Institute for Dynamics and Self-Organization, Göttingen 37077, Germany.
概括
暴露前预防 (PrEP) 可能会增加STI检测率,不一定是传播,由于加强查. 优化查策略对于PrEP计划来说至关重要,以有效地减少艾滋病毒和性传播疾病的发生率.
科学领域:
- 流行病学 流行病学
- 数学建模的数学建模
- 公共卫生 公共卫生
背景情况:
- 艾滋病毒暴露前预防 (PrEP) 的实施与与男性发生性关系的男性中细菌性传播感染率上升的同时.
- 这种趋势引发了关于PrEP对STI传播动态的潜在意外影响的问题.
研究的目的:
- 开发一个动态模型,协调关于PREP和STI率的相互矛盾的流行病学观察结果.
- 调查风险介导行为,减少避孕套使用和无症状查对同时传播艾滋病毒和性传播疾病的影响.
主要方法:
- 开发了一种最小的动态模型,用于HIV和克拉米迪亚的联合传播.
- 综合机制:风险介导行为,减少PrEP用户的避孕套使用,以及与PrEP相关的性传播疾病查.
- 系统地映射参数空间,包括prep吸收,查频率和风险感知.
主要成果:
- 确定了一个"测试悖论",其中真正的性传播疾病患病率可能下降,而观察到的检测率上升.
- 证明 PrEP 摄入量增加会放大查强度,从而增加检测.
- 根据PrEP吸收,查和风险感知,发现了这种悖论产生的条件.
结论:
- 调和了PrEP和STI动态的相互矛盾的流行病学证据.
- 强调了无症状查策略在确定PrEP对性传播疾病动态的净影响方面的关键作用.
- 强调调整查和治疗政策,以最大限度地提高效益 (减少艾滋病毒/性传播疾病的发病率) 和最大限度地降低风险 (例如,抗菌素耐药性).
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