EMOD

Vector genetics, insecticide resistance and gene drives: an agent-based modeling approach to evaluate malaria transmission and elimination

Vector control has been a key component in the fight against malaria for decades, and chemical insecticides are critical to the success of vector control programs worldwide. However, increasing resistance to insecticides threatens to undermine these efforts. Understanding the evolution and propagation of resistance is thus imperative to mitigating loss of intervention effectiveness. Additionally, accelerated…
The effect of 90-90-90 on HIV-1 incidence and mortality in eSwatini: a mathematical modelling study

Background The rapid scale-up of antiretroviral therapy (ART) towards the UNAIDS 90-90-90 goals over the last decade has sparked considerable debate as to whether universal test and treat can end the HIV-1 epidemic in sub-Saharan Africa. We aimed to develop a network transmission model, calibrated to capture age-specific and sex-specific gaps in the scale-up of…
Impact along the HIV pre-exposure prophylaxis â€œcascade of preventionâ€ in western Kenya: a mathematical modelling study

Introduction Over one hundred implementation studies of HIV pre-exposure prophylaxis (PrEP) are completed, underway or planned. We synthesized evidence from these studies to inform mathematical modelling of the prevention cascade for oral and long-acting PrEP in the setting of western Kenya, one of the world’s most heavily HIV-affected regions. Methods We incorporated steps of the…
Cost-effectiveness of point-of-care testing with task-shifting for HIV care in South Africa: a modelling study

Background The number of people on antiretroviral therapy (ART) requiring treatment monitoring in low-resource settings is rapidly increasing. Point-of-care (POC) testing for ART monitoring might alleviate burden on centralised laboratories and improve clinical outcomes, but its cost-effectiveness is unknown. Methods We used cost and effectiveness data from the STREAM trial in South Africa (February, 2017â€“October,…
Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision

Background Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV and has the potential to significantly impact the HIV epidemic. Given limited resources for HIV prevention, identifying PrEP provision strategies that maximize impact is critical. Methods We used a stochastic individual-based network model to evaluate the direct (infections prevented among PrEP users) and indirect (infections…
Cost-effectiveness of using environmental surveillance to target the roll-out typhoid conjugate vaccine

Highlights • Environmental surveillance is an alternative to case-based surveillance. • Vaccine targeted to high-risk populations is less expensive than national campaigns. • Surveillance-based vaccine introductions are more cost-effective than blanket decisions. • Environmental surveillance is valuable, even if costs are higher than anticipated.
Optimization of frequency and targeting of measles supplemental immunization activities in Nigeria: A cost-effectiveness analysis

Background Measles causes significant childhood morbidity in Nigeria. Routine immunization (RI) coverage is around 40% country-wide, with very high levels of spatial heterogeneity (3–86%), with supplemental immunization activities (SIAs) at 2-year or 3-year intervals. We investigated cost savings and burden reduction that could be achieved by adjusting the inter-campaign interval by region. Methods We modeled…
Reducing malaria burden and accelerating elimination with long-lasting systemic insecticides: a modelling study of three potential use cases

Background While bed nets and insecticide spraying have had significant impact on malaria burden in many endemic regions, outdoor vector feeding and insecticide resistance may ultimately limit their contribution to elimination and control campaigns. Complementary vector control methods such as endectocides or systemic insecticides, where humans or animals are treated with drugs that kill mosquitoes…
The influence of mobility among high-risk populations on HIV transmission in Western Kenya

Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus (HIV). Although female sex workers (FSW) and their male clients are known to be at high risk for HIV, HIV prevalence across regions in Western Kenya is not strongly correlated with the fraction of women engaged in commercial sex. An…
Impact of mass drug administration campaigns depends on interaction with seasonal human movement

Background Mass drug administration (MDA) is a control and elimination tool for treating infectious diseases. For malaria, it is widely accepted that conducting MDA during the dry season results in the best outcomes. However, seasonal movement of populations into and out of MDA target areas is common in many places and could potentially fundamentally limit…