Arquivo da tag: Epidemiologia

Mathematics Provides a Shortcut to Timely, Cost-Effective Interventions for HIV (Science Daily)

Apr. 15, 2013 — Mathematical estimates of treatment outcomes can cut costs and provide faster delivery of preventative measures.

South Africa is home to the largest HIV epidemic in the world with a total of 5.6 million people living with HIV. Large-scale clinical trials evaluating combination methods of prevention and treatment are often prohibitively expensive and take years to complete. In the absence of such trials, mathematical models can help assess the effectiveness of different HIV intervention combinations, as demonstrated in a new study by Elisa Long and Robert Stavert from Yale University in the US. Their findings appear in the Journal of General Internal Medicine, published by Springer.

Currently 60 percent of individuals in need of treatment for HIV in South Africa do not receive it. The allocation of scant resources to fight the HIV epidemic means each strategy must be measured in terms of cost versus benefit. A number of new clinical trials have presented evidence supporting a range of biomedical interventions that reduce transmission of HIV. These include voluntary male circumcision — now recommended by the World Health Organization and Joint United Nations Programme on HIV/AIDS as a preventive strategy — as well as vaginal microbicides and oral pre-exposure prophylaxis, all of which confer only partial protection against HIV. Long and Stavert show that a combination portfolio of multiple interventions could not only prevent up to two-thirds of future HIV infections, but is also cost-effective in a resource-limited setting such as South Africa.

The authors developed a mathematical model accounting for disease progression, mortality, morbidity and the heterosexual transmission of HIV to help forecast future trends in the disease. Using data specific for South Africa, the authors estimated the health benefits and cost-effectiveness of a “combination approach” using all three of the above methods in tandem with current levels of antiretroviral therapy, screening and counseling.

For each intervention, they calculated the HIV incidence and prevalence over 10 years. At present rates of screening and treatment, the researchers predict that HIV prevalence will decline from 19 percent to 14 percent of the population in the next 10 years. However, they calculate that their combination approach including male circumcision, vaginal microbicides and oral pre-exposure prophylaxis could further reduce HIV prevalence to 10 percent over that time scale — preventing 1.5 million HIV infection over 10 years — even if screening and antiretroviral therapy are kept at current levels. Increasing antiretroviral therapy use and HIV screening frequency in addition could avert more than 2 million HIV infections over 10 years, or 60 percent of the projected total.

The researchers also determined a hierarchy of effectiveness versus cost for these intervention strategies. Where budgets are limited, they suggest money should be allocated first to increasing male circumcision, then to more frequent HIV screening, use of vaginal microbicides and increasing antiretroviral therapy. Additionally, they calculate that omitting pre-exposure prophylaxis from their combination strategy could offer 90 percent of the benefits of treatment for less than 25 percent of the costs.

The authors conclude: “In the absence of multi-intervention randomized clinical or observational trials, a mathematical HIV epidemic model provides useful insights about the aggregate benefit of implementing a portfolio of biomedical, diagnostic and treatment programs. Allocating limited available resources for HIV control in South Africa is a key priority, and our study indicates that a multi-intervention HIV portfolio could avert nearly two-thirds of projected new HIV infections, and is a cost-effective use of resources.”

Journal Reference:

  1. Long, E.F. and Stavert, R.R. Portfolios of biomedical HIV interventions in South Africa: a cost-effectiveness analysisJournal of General Internal Medicine, 2013 DOI:10.1007/s11606-013-2417-1

Rooting out Rumors, Epidemics, and Crime — With Math (Science Daily)

ScienceDaily (Aug. 10, 2012) — A team of EPFL scientists has developed an algorithm that can identify the source of an epidemic or information circulating within a network, a method that could also be used to help with criminal investigations.

Investigators are well aware of how difficult it is to trace an unlawful act to its source. The job was arguably easier with old, Mafia-style criminal organizations, as their hierarchical structures more or less resembled predictable family trees.

In the Internet age, however, the networks used by organized criminals have changed. Innumerable nodes and connections escalate the complexity of these networks, making it ever more difficult to root out the guilty party. EPFL researcher Pedro Pinto of the Audiovisual Communications Laboratory and his colleagues have developed an algorithm that could become a valuable ally for investigators, criminal or otherwise, as long as a network is involved. The team’s research was published August 10, 2012, in the journal Physical Review Letters.

Finding the source of a Facebook rumor

“Using our method, we can find the source of all kinds of things circulating in a network just by ‘listening’ to a limited number of members of that network,” explains Pinto. Suppose you come across a rumor about yourself that has spread on Facebook and been sent to 500 people — your friends, or even friends of your friends. How do you find the person who started the rumor? “By looking at the messages received by just 15-20 of your friends, and taking into account the time factor, our algorithm can trace the path of that information back and find the source,” Pinto adds. This method can also be used to identify the origin of a spam message or a computer virus using only a limited number of sensors within the network.

Trace the propagation of an epidemic

Out in the real world, the algorithm can be employed to find the primary source of an infectious disease, such as cholera. “We tested our method with data on an epidemic in South Africa provided by EPFL professor Andrea Rinaldo’s Ecohydrology Laboratory,” says Pinto. “By modeling water networks, river networks, and human transport networks, we were able to find the spot where the first cases of infection appeared by monitoring only a small fraction of the villages.”

The method would also be useful in responding to terrorist attacks, such as the 1995 sarin gas attack in the Tokyo subway, in which poisonous gas released in the city’s subterranean tunnels killed 13 people and injured nearly 1,000 more. “Using this algorithm, it wouldn’t be necessary to equip every station with detectors. A sample would be sufficient to rapidly identify the origin of the attack, and action could be taken before it spreads too far,” says Pinto.

Identifying the brains behind a terrorist attack

Computer simulations of the telephone conversations that could have occurred during the terrorist attacks on September 11, 2001, were used to test Pinto’s system. “By reconstructing the message exchange inside the 9/11 terrorist network extracted from publicly released news, our system spit out the names of three potential suspects — one of whom was found to be the mastermind of the attacks, according to the official enquiry.”

The validity of this method thus has been proven a posteriori. But according to Pinto, it could also be used preventatively — for example, to understand an outbreak before it gets out of control. “By carefully selecting points in the network to test, we could more rapidly detect the spread of an epidemic,” he points out. It could also be a valuable tool for advertisers who use viral marketing strategies by leveraging the Internet and social networks to reach customers. For example, this algorithm would allow them to identify the specific Internet blogs that are the most influential for their target audience and to understand how in these articles spread throughout the online community.