The relative impacts of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996-2013 : A modeling study
Bibliographic record
Abstract
Background—Antiretroviral therapy (ART) and harm reduction services have been cited as key contributors to the control of the HIV epidemic, however the specific contribution of the latter has been questioned due to uncertainty in the true efficacy of ART on HIV transmission through needle sharing. Using provincial data on OAT uptake and needle distribution volumes, we aimed to isolate the independent effects of harm reduction services and ART on HIV transmission via needle sharing in British Columbia, from 1996–2013. Methods—Using comprehensive linked population-level data, we populated a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in BC from 1996–2013. HIV incidence, mortality, and quality-adjusted life years (QALYs) were estimated. We estimated scenarios designed to isolate the independent effects of harm reduction services and ART (assuming 50% (10%–90%) efficacy) in reducing HIV incidence through needle sharing. Structural and parameter uncertainty was investigated. Findings—We estimated that 3204 (2402–4589) incident HIV cases were averted between 1996 and 2013 as a result of the combined effect of the expansion of harm reduction services and ART coverage on HIV transmission via needle sharing. In a hypothetical scenario assuming ART had zero effect on transmission through needle sharing, we estimated harm reduction services alone would have accounted for 77% (62%–95%) of averted HIV incidence. In a separate hypothetical scenario where harm reduction services remained at 1996 levels, we estimated ART alone would have accounted for 44% (10%–67%) of averted HIV incidence. Due to high distribution volumes, needle distribution predominantly accounted for incidence reductions attributable to harm reduction, however OAT provided substantially greater QALY gains. Interpretation—If the true efficacy of ART in preventing HIV transmission through needle sharing is closer to its efficacy in sexual transmission, ART’s impact on incident cases averted may be greater than that of harm reduction. Nonetheless, harm reduction services played a vital role in reducing HIV incidence in BC, and should be viewed as critical and cost-effective tools in combination implementation strategies to reduce the public health and economic burden of HIV/AIDS.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".