Imperial College London
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DrLouisaMoorhouse

Faculty of Medicine, School of Public Health

Research Associate
 
 
 
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Contact

 

l.moorhouse

 
 
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Location

 

School of Public HealthWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Pickles:2023:10.1016/S2214-109X(23)00206-1,
author = {Pickles, M and Gregson, S and Moorhouse, L and Dadirai, T and Dzamatira, F and Mandizvidza, P and Maswera, R and Museka, T and Schaefer, R and Skovdal, M and Thomas, R and Tsenesa, B and Mugurungi, O and Nyamukapa, C and Hallett, T},
doi = {10.1016/S2214-109X(23)00206-1},
journal = {The Lancet Global Health},
pages = {e1105--e1113},
title = {Strengthening the HIV prevention cascade to maximise epidemiological impact in Eastern Zimbabwe: a modelling study},
url = {http://dx.doi.org/10.1016/S2214-109X(23)00206-1},
volume = {11},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background HIV prevention cascades provide a systematic understanding of barriers to prevention. In this study we use mathematical modelling to understand the consequences of these barriers and how the cascade could be strengthened to maximise epidemiological impact, providing potentially important insights for programmes. Methods We use an individual-based model of HIV transmission (PopART-IBM), calibrated to cohort data from eastern Zimbabwe. HIV prevention cascade estimates from this cohort are used as probabilities for indicators in the model representing an individual’s ‘motivation’, ‘access’ and ‘capacity to use effectively’ pre-exposure prophylaxis, voluntary male medical circumcision and condom use. We examine how current barriers affect the number and distribution of HIV infections compared to a no-barrier scenario. Using assumptions about how interventions could strengthen the HIV prevention cascade, we estimate the reduction in HIV infections over a ten-year period through addressing different elements of the cascade.Findings 22,000 new potentially ‘avertable’ HIV infections will occur over the next ten years due to existing HIV prevention cascade barriers, 74·2% of the 28,000 new infections that would occur with existing barriers in a population of approximately 1·2 million adults. Removing these barriers would reduce HIV incidence below the benchmarks for epidemic elimination. Addressing all cascade steps in one priority population is much more impactful than addressing one step across all populations. Interpretation Interventions exists in eastern Zimbabwe to reduce HIV towards elimination, but barriers of motivation, access and effective use prevent their full effect being realised. Interventions need to be multi-layered, and address all steps along the HIV prevention cascade. Models incorporating the HIV prevention cascade can help identify the main barriers to greater impact.Funding
AU  - Pickles,M
AU  - Gregson,S
AU  - Moorhouse,L
AU  - Dadirai,T
AU  - Dzamatira,F
AU  - Mandizvidza,P
AU  - Maswera,R
AU  - Museka,T
AU  - Schaefer,R
AU  - Skovdal,M
AU  - Thomas,R
AU  - Tsenesa,B
AU  - Mugurungi,O
AU  - Nyamukapa,C
AU  - Hallett,T
DO  - 10.1016/S2214-109X(23)00206-1
EP  - 1113
PY  - 2023///
SN  - 2214-109X
SP  - 1105
TI  - Strengthening the HIV prevention cascade to maximise epidemiological impact in Eastern Zimbabwe: a modelling study
T2  - The Lancet Global Health
UR  - http://dx.doi.org/10.1016/S2214-109X(23)00206-1
UR  - http://hdl.handle.net/10044/1/104128
VL  - 11
ER  -
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