Abstract
ObjectiveWe compared the impact and costs of HIV prevention strategies focusing on youth (15–24 year-old persons) versus on adults (15+ year-old persons), in a high-HIV burden context of a large generalized epidemic.DesignCompartmental age-structured mathematical model of HIV transmission in Nyanza, Kenya.InterventionsThe interventions focused on youth were high coverage HIV testing (80% of youth), treatment at diagnosis (TasP, i.e., immediate start of antiretroviral therapy [ART]) and 10% increased condom usage for HIV-positive diagnosed youth, male circumcision for HIV-negative young men, pre-exposure prophylaxis (PrEP) for high-risk HIV-negative females (ages 20–24 years), and cash transfer for in-school HIV-negative girls (ages 15–19 years). Permutations of these were compared to adult-focused HIV testing coverage with condoms and TasP.ResultsThe youth-focused strategy with ART treatment at diagnosis and condom use without adding interventions for HIV-negative youth performed better than the adult-focused strategy with adult testing reaching 50–60% coverage and TasP/condoms. Over the long term, the youth-focused strategy approached the performance of 70% adult testing and TasP/condoms. When high coverage male circumcision also is added to the youth-focused strategy, the combined intervention outperformed the adult-focused strategy with 70% testing, for at least 35 years by averting 94,000 more infections, averting 5.0 million more disability-adjusted life years (DALYs), and saving US$46.0 million over this period. The addition of prevention interventions beyond circumcision to the youth-focused strategy would be more beneficial if HIV care costs are high, or when program delivery costs are relatively high for programs encompassing HIV testing coverage exceeding 70%, TasP and condoms to HIV-infected adults compared to combination prevention programs among youth.ConclusionFor at least the next three decades, focusing in high burden settings on high coverage HIV testing, ART treatment upon diagnosis, condoms and male circumcision among youth may outperform adult-focused ART treatment upon diagnosis programs, unless the adult testing coverage in these programs reaches very high levels (>70% of all adults reached) at similar program costs. Our results indicate the potential importance of age-targeting for HIV prevention in the current era of ‘test and start, ending AIDS’ goals to ameliorate the HIV epidemic globally.
Highlights
The world has committed to ambitious targets to reach high levels of HIV testing and starting antiretroviral therapy (ART) upon HIV diagnosis to achieve viral suppression as well as to prevent HIV infections in the first place [1]
When high coverage male circumcision is added to the youth-focused strategy, the combined intervention outperformed the adult-focused strategy with 70% testing, for at least 35 years by averting 94,000 more infections, averting 5.0 million more disability
Our results indicate the potential importance of age-targeting for HIV prevention in the current era of ‘test and start, ending AIDS’ goals to ameliorate the HIV epidemic globally
Summary
The world has committed to ambitious targets to reach high levels of HIV testing and starting antiretroviral therapy (ART) upon HIV diagnosis to achieve viral suppression as well as to prevent HIV infections in the first place [1]. Recent publication of the SEARCH study conducted in the high HIVburden countries of Kenya and Uganda using a mobile multidisease approach found that while otherwise highly successful in getting adults to HIV test and start ART, and young people tested at higher levels than before [6], youth need further outreach for optimal HIV testing and treatment. Several lines of evidence indicate that young adults/youth, 15–24 years of age, are a key demographic to target with HIV prevention interventions. Ecological studies have indicated that sexual debut (including forced coitarche) at a young age is more common in sub-Saharan African countries with high HIV prevalence and generalized epidemics [9]. 80% of youth living with HIV globally are in sub-Saharan Africa, encompassing primarily young females [12]; further, in generalized epidemics youth are exposed to HIV risk over their entire sexual lifespan
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
