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Evaluating the potential impact of vaginal microbicides to reduce the risk of acquiring HIV in female sex workers.
AIDS. 2005 Mar 04; 19(4):413-21.AIDS

Abstract

OBJECTIVES

The following questions were addressed: would the introduction of vaginal microbicides substantially reduce the risk of female sex workers (FSWs) acquiring HIV? Which factor would it be most important to maximize, microbicide efficacy or microbicide use? What level of microbicide efficacy and use would be necessary to counterbalance a possible reduction in condom use?

DESIGN

Mathematical modeling, with parameter estimations from available literature.

METHODS

Risk equations were developed and Monte Carlo simulations were performed to model a FSW's daily risk of HIV acquisition currently, and after, microbicide introduction. Uncertainty and sensitivity analyses were used as well as tornado plots for two ranges of microbicide efficacy (30-50%) and (50-80%). Risk was estimated for FSWs whose clients sometimes (10-50%) use condoms, and those whose clients never use condoms. An analytical threshold for which reducing condom use increases risk was estimated.

RESULTS

For both groups of FSWs, daily risk would decrease by approximately 17% or approximately 28% using 30-50% or 50-80% effective microbicides, respectively. Increasing microbicide use would have greater impact on reducing risk than increasing microbicide efficacy. The microbicide efficacy and usage required to ensure that 'condom replacement' does not increase a FSW's risk of acquiring HIV was calculated.

CONCLUSIONS

Microbicides could substantially reduce FSWs' risk of acquiring HIV; absolute decrease in risk would be greatest in high-prevalence regions. The public health impact of microbicides will depend upon usage and efficacy. Even if the microbicides that become available are only low-to-moderately effective, the probability that risk in FSWs will increase (due to replacing condoms with microbicides) is low.

Authors+Show Affiliations

Smith RJ
Department of Biomathematics and UCLA AIDS Institute, David Geffen School of Medicine at UCLA, Westwood, California 90024, USA.
Bodine EN
No affiliation info available
Wilson DP
No affiliation info available
Blower SM
No affiliation info available

MeSH

Anti-HIV AgentsAnti-Infective Agents, LocalCondomsDrug UtilizationFemaleHIV InfectionsHumansModels, BiologicalRisk AssessmentSafe SexSex WorkSexual BehaviorTreatment OutcomeVaginal Creams, Foams, and Jellies

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15750395

Citation

Smith, Robert J., et al. "Evaluating the Potential Impact of Vaginal Microbicides to Reduce the Risk of Acquiring HIV in Female Sex Workers." AIDS (London, England), vol. 19, no. 4, 2005, pp. 413-21.
Smith RJ, Bodine EN, Wilson DP, et al. Evaluating the potential impact of vaginal microbicides to reduce the risk of acquiring HIV in female sex workers. AIDS. 2005;19(4):413-21.
Smith, R. J., Bodine, E. N., Wilson, D. P., & Blower, S. M. (2005). Evaluating the potential impact of vaginal microbicides to reduce the risk of acquiring HIV in female sex workers. AIDS (London, England), 19(4), 413-21.
Smith RJ, et al. Evaluating the Potential Impact of Vaginal Microbicides to Reduce the Risk of Acquiring HIV in Female Sex Workers. AIDS. 2005 Mar 4;19(4):413-21. PubMed PMID: 15750395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the potential impact of vaginal microbicides to reduce the risk of acquiring HIV in female sex workers. AU - Smith,Robert J, AU - Bodine,Erin N, AU - Wilson,David P, AU - Blower,Sally M, PY - 2005/3/8/pubmed PY - 2005/5/4/medline PY - 2005/3/8/entrez SP - 413 EP - 21 JF - AIDS (London, England) JO - AIDS VL - 19 IS - 4 N2 - OBJECTIVES: The following questions were addressed: would the introduction of vaginal microbicides substantially reduce the risk of female sex workers (FSWs) acquiring HIV? Which factor would it be most important to maximize, microbicide efficacy or microbicide use? What level of microbicide efficacy and use would be necessary to counterbalance a possible reduction in condom use? DESIGN: Mathematical modeling, with parameter estimations from available literature. METHODS: Risk equations were developed and Monte Carlo simulations were performed to model a FSW's daily risk of HIV acquisition currently, and after, microbicide introduction. Uncertainty and sensitivity analyses were used as well as tornado plots for two ranges of microbicide efficacy (30-50%) and (50-80%). Risk was estimated for FSWs whose clients sometimes (10-50%) use condoms, and those whose clients never use condoms. An analytical threshold for which reducing condom use increases risk was estimated. RESULTS: For both groups of FSWs, daily risk would decrease by approximately 17% or approximately 28% using 30-50% or 50-80% effective microbicides, respectively. Increasing microbicide use would have greater impact on reducing risk than increasing microbicide efficacy. The microbicide efficacy and usage required to ensure that 'condom replacement' does not increase a FSW's risk of acquiring HIV was calculated. CONCLUSIONS: Microbicides could substantially reduce FSWs' risk of acquiring HIV; absolute decrease in risk would be greatest in high-prevalence regions. The public health impact of microbicides will depend upon usage and efficacy. Even if the microbicides that become available are only low-to-moderately effective, the probability that risk in FSWs will increase (due to replacing condoms with microbicides) is low. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/15750395/Evaluating_the_potential_impact_of_vaginal_microbicides_to_reduce_the_risk_of_acquiring_HIV_in_female_sex_workers_ DB - PRIME DP - Unbound Medicine ER -