Mathematical models of HIV epidemics in Australia and South East Asia

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Copyright: Hoare, Alexander Noel Michael
This thesis consists of a series of publications that address timely public health questions in the field of mathematical epidemiology of HIV/AIDS and sexually transmissible infections (STIs). Mathematical epidemiology requires the forecasting of epidemic trajectories coupled with degrees of uncertainty. This study commenced with the development of new software and utilisation of techniques from a variety of disciplines to assist the conduct of uncertainty and sensitivity analyses. A user-friendly software package was developed and also used in the subsequent projects of this study. The number of HIV diagnoses in Australia has been increasing over the past decade and it was timely for a detailed analysis to be conducted. This study investigated the differing trends observed in three States of Australia: New South Wales, Queensland, and Victoria. The model included epidemiological, clinical, behavioural, and biological data to analyse and identify the differences in each State. It found that the only way to fit the data was to incorporate changes in other STIs as interactive biological cofactors. This model was then extended to examine the impact of testing and early treatment of HIV as a means of preventing new HIV infections. It was found that increasing testing rates for HIV can have a significant impact on reducing further secondary infections. This has since become a topic of very large international interest. Since syphilis epidemics have resurged and could facilitate HIV transmission, possible public health intervention strategies were simulated using a detailed individual-based model. This formed the foundation for Australia’s National Gay Men’s Syphilis Action Plan (NGMSAP). This study then examined the potential benefits in HIV incidence that could be due to the implementation of the NGMSAP. Lastly, this study examined an important current issue for neighbouring countries in the region, namely, the impact of universal HIV treatment access in Southeast Asia on the development of drug resistance. This model-based investigation found that a high prevalence of drug resistance can potentially develop, however, increased treatment access will likely reduce the incidence of new HIV infections. It also found that regular viral load tests can mitigate the prevalence of drug resistance in the population.
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Hoare, Alexander Noel Michael
Wilson, David
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PhD Doctorate
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