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Statistical Communications in Infectious Diseases

Editor-in-Chief: Evans, Scott

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Who Will Benefit from a Wide-Scale Introduction of Vaginal Microbicides in Developing Countries?

Dobromir T Dimitrov / Benoit Masse / Marie-Claude Boily
Published Online: 2010-07-07 | DOI: https://doi.org/10.2202/1948-4690.1012

Vaginal microbicides (VMB) are currently among the few biomedical interventions designed to help women reduce their risk of acquiring HIV infection. However, the microbicide containing antiretroviral (ARV-VMB) may lead to the development of antiretroviral resistance and could paradoxically become more beneficial to men at the population level.We developed a mathematical model to study the impact of a wide-scale population usage of VMB in a heterosexual population. Gender ratios of prevented infections and prevalence reduction are evaluated in 63 different intervention schedules including continuous and interrupted ARV-VMB use by HIV-positive women. The influence of different factors on population-level benefits is also studied through Monte Carlo simulations using parameters sampled from primary ranges representative of developing countries.Our analysis indicates that women are more likely than men to benefit from ARV-VMB use since 78-80% of the total 63,000 simulations investigated (under different parameter sets) showed a female advantage whether benefit is measured as cumulative number of infections prevented, the percentage of cumulative infections prevented, or the expected reduction in prevalence. Stratified analysis by scenarios indicates that the likelihood of a male advantage with respect to the fractions of prevented infections varies from 6% to 49% among the scenarios. It is substantial only if the risk of systemic absorption and development of resistance to ARV-VMB is high and the HIV-positive women use VMB indefinitely without interruption. Therefore, the use of ARV-VMB, with successful control measures restricting usage by HIV-positive women, is still very much a female prevention tool.

Keywords: mathematical model; HIV transmission; HIV prevention; vaginal microbicide

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Published Online: 2010-07-07

Citation Information: Statistical Communications in Infectious Diseases, ISSN (Online) 1948-4690, DOI: https://doi.org/10.2202/1948-4690.1012.

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©2011 Walter de Gruyter GmbH & Co. KG, Berlin/Boston. Copyright Clearance Center

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Dobromir Dimitrov, Marie-Claude Boily, Jeannie Marrazzo, Richard Beigi, Elizabeth R. Brown, and Claire Thorne
PLoS ONE, 2013, Volume 8, Number 9, Page e73770
Dobromir T. Dimitrov, Marie-Claude Boily, Rebecca F. Baggaley, and Benoit Masse
Journal of Theoretical Biology, 2011, Volume 288, Page 9

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