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Title: The spread and control of HIV in southern Africa
Author: Eaton, Jeffrey
ISNI:       0000 0004 2736 9166
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2013
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HIV has disproportionately affected southern Africa. This region, which comprises 2% of the worlds population, is home to an estimated 34% of all people living with HIV, 29% of new HIV infections globally in 2010, and 30% of AIDS-related deaths. A strengthened response to the epidemic by countries in southern Africa in recent years has brought life-prolonging antiretroviral therapy to the majority of those in need of treatment, and declines from peak levels of HIV incidence over the past decade are a reason for optimism. But, in 2010, 770,000 new HIV infections occurred. A better understanding of why the epidemic has spread so severely in this region is required to inform strategies to reduce and eventually eliminate new HIV infections. This thesis uses data analysis and mathematical modelling to understand the interaction between behavioural and biological factors that may have contributed to the spread of HIV in southern Africa, and the implications of these for controlling the epidemic. It focuses specifically on two topics of recent attention for public health decision makers in southern Africa: concurrent sexual partnerships and HIV treatment as prevention. Chapters explore the interaction between high HIV infectiousness during primary HIV infection and concurrent sexual partnerships, describe and evaluate a consensus indicator for concurrency, develop a method to adjust for high levels of missing data in sexual behaviour surveys and examine trends in sexual behaviours in a high HIV prevalence population in South Africa, create a mathematical model to examine the potential impact of antiretroviral therapy on HIV incidence in hyperendemic settings, and systematically compare the predictions of twelve different mathematical models of the impact of HIV treatment as prevention in South Africa. Taken together, through these topics we come to understand more broadly the complexity of the epidemiological context in which HIV spreads in southern Africa.
Supervisor: Garnett, Geoffrey ; Hallett, Timothy ; White, Peter Sponsor: Bill and Melinda Gates Foundation
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral