Designing Rollout Plans for HIV Interventions in Africa Using Optimal Control Theory

We are currently developing detailed spatially-explicit data-based HIV transmission dynamic models and using these models to design optimal interventions for preventing HIV infections. We are collaborating with colleagues at the African Comprehensive HIV and AIDS Program (ACHAP); ACHAP is an organization that involves both the Government of Botswana and the Bill and Melinda Gates Foundation. We are designing optimal rollout plans for interventions based on male circumcision (MC) and pre exposure prophylaxis (PrEP) in Botswana using data-based models. Clinical trials of MC have shown that MC is ~60% effective in protecting men against HIV infection. The efficacy of PrEP is currently being evaluated in clinical trials; PReP is based on antiretrovirals and is designed to prevent men and women against infection.  Botswana has one of the highest levels of HIV worldwide; ~40% of its’ 730,000 adults between the ages of 15 & 49 are infected. By constructing detailed spatially-explicit transmission models and employing mathematical optimization techniques our modeling will be able to show how to maximize the effectiveness of MC and PrEP interventions. Specifically, we will identify the geographic locations where the rollout of these interventions should begin, and determine the gender (for PrEP) and age-groups (for PrEP and MC) that should be targeted. By developing high resolution data-based spatial risk maps we will be able to make realistic predictions for the potential epidemiological impact of MC (and PrEP) on incidence (and drug resistance) in Botswana. In addition the risk maps will enable us to assess the feasibility of the Governments’ MC rollout plan. The theoretical frameworks that we are developing will be able to be used to determine and evaluate critical health policy decisions regarding MC and PrEP interventions in Botswana and other African countries.