HIV incidence among people who inject drugs in the middle east and North Africa: Mathematical modelling analysis

Ghina R. Mumtaz, Susanne Awad, Ali Feizzadeh, Helen A. Weiss, Laith Aburaddad

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Emerging HIV epidemics have been documented among people who inject drugs (PWID) in the Middle East and North Africa (MENA). This study estimates the HIV incidence among PWID due to sharing needles/syringes in MENA. It also delineates injecting drug use role as a driver of the epidemic in the population, and estimates impact of interventions. Methods: A mathematical model of HIV transmission among PWID was applied in seven MENA countries with sufficient and recent epidemiological data and HIV prevalence ≥1% among PWID. Estimations of incident and/or prevalent infections among PWID, ex-PWID and sexual partners of infected current and ex-PWID were conducted. Results: The estimated HIV incidence rate for 2017 among PWID ranged between 0.7% per person-year (ppy) in Tunisia and 7.8% ppy in Pakistan, with Libya being an outlier (24.8% ppy). The estimated number of annual new infections was lowest in Tunisia (n = 79) and Morocco (n = 99), and highest in Iran and Pakistan (approximately n = 6700 each). In addition, 20 to 2208 and 5 to 837 new annual infections were estimated across the different countries among sexual partners of PWID and ex-PWID respectively. Since epidemic emergence, the number of total ever acquired incident infections across countries was 706 to 90,015 among PWID, 99 to 18,244 among sexual partners of PWID, and 16 to 4360 among sexual partners of ex-PWID. The estimated number of prevalent infections across countries was 341 to 23,279 among PWID, 119 to 16,540 among ex-PWID, 67 to 10,752 among sexual partners of PWID, and 12 to 2863 among sexual partners of ex-PWID. Increasing antiretroviral therapy (ART) coverage to the global target of 81% – factoring in ART adherence and current coverage – would avert about half of new infections among PWID and their sexual partners. Combining ART with harm reduction could avert over 90% and 70% of new infections among PWID and their sexual partners respectively. Conclusions: There is considerable HIV incidence among PWID in MENA. Of all new infections ultimately due to injecting drug use, about 75% are among PWID and the rest among sexual partners. Of all prevalent infections ultimately attributed to injecting drug use as epidemic driver, about half are among PWID, 30% among ex-PWID and 20% among sexual partners of PWID and ex-PWID. These findings call for scale-up of services for PWID, including harm reduction as well as testing and treatment services.

Original languageEnglish
Article numbere25102
JournalJournal of the International AIDS Society
Volume21
Issue number3
DOIs
Publication statusPublished - 1 Jan 2018

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Northern Africa
Eastern Africa
Middle East
HIV
Incidence
Pharmaceutical Preparations
Sexual Partners
Infection
Needle Sharing
Harm Reduction
Tunisia
Pakistan

Keywords

  • HIV
  • Incidence
  • Intervention
  • Mathematical modelling
  • Middle east and north africa
  • People who inject drugs
  • Prevalence

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

HIV incidence among people who inject drugs in the middle east and North Africa : Mathematical modelling analysis. / Mumtaz, Ghina R.; Awad, Susanne; Feizzadeh, Ali; Weiss, Helen A.; Aburaddad, Laith.

In: Journal of the International AIDS Society, Vol. 21, No. 3, e25102, 01.01.2018.

Research output: Contribution to journalArticle

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title = "HIV incidence among people who inject drugs in the middle east and North Africa: Mathematical modelling analysis",
abstract = "Emerging HIV epidemics have been documented among people who inject drugs (PWID) in the Middle East and North Africa (MENA). This study estimates the HIV incidence among PWID due to sharing needles/syringes in MENA. It also delineates injecting drug use role as a driver of the epidemic in the population, and estimates impact of interventions. Methods: A mathematical model of HIV transmission among PWID was applied in seven MENA countries with sufficient and recent epidemiological data and HIV prevalence ≥1{\%} among PWID. Estimations of incident and/or prevalent infections among PWID, ex-PWID and sexual partners of infected current and ex-PWID were conducted. Results: The estimated HIV incidence rate for 2017 among PWID ranged between 0.7{\%} per person-year (ppy) in Tunisia and 7.8{\%} ppy in Pakistan, with Libya being an outlier (24.8{\%} ppy). The estimated number of annual new infections was lowest in Tunisia (n = 79) and Morocco (n = 99), and highest in Iran and Pakistan (approximately n = 6700 each). In addition, 20 to 2208 and 5 to 837 new annual infections were estimated across the different countries among sexual partners of PWID and ex-PWID respectively. Since epidemic emergence, the number of total ever acquired incident infections across countries was 706 to 90,015 among PWID, 99 to 18,244 among sexual partners of PWID, and 16 to 4360 among sexual partners of ex-PWID. The estimated number of prevalent infections across countries was 341 to 23,279 among PWID, 119 to 16,540 among ex-PWID, 67 to 10,752 among sexual partners of PWID, and 12 to 2863 among sexual partners of ex-PWID. Increasing antiretroviral therapy (ART) coverage to the global target of 81{\%} – factoring in ART adherence and current coverage – would avert about half of new infections among PWID and their sexual partners. Combining ART with harm reduction could avert over 90{\%} and 70{\%} of new infections among PWID and their sexual partners respectively. Conclusions: There is considerable HIV incidence among PWID in MENA. Of all new infections ultimately due to injecting drug use, about 75{\%} are among PWID and the rest among sexual partners. Of all prevalent infections ultimately attributed to injecting drug use as epidemic driver, about half are among PWID, 30{\%} among ex-PWID and 20{\%} among sexual partners of PWID and ex-PWID. These findings call for scale-up of services for PWID, including harm reduction as well as testing and treatment services.",
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KW - Incidence

KW - Intervention

KW - Mathematical modelling

KW - Middle east and north africa

KW - People who inject drugs

KW - Prevalence

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