Publication in special JIAS issue

Our team’s paper diving into the transmission population attributable fraction in the context of HIV epidemics and key populations was published in a special JIAS issue on “HIV in underserved and marginalized populations in sub-Saharan Africa: a growing challenge”.

There are many ways to “characterize” an epidemic, and the process is referred to as an epidemic appraisal. A common metric in HIV epidemic appraisals is the distribution of new infections across subgroups. Another metric is the transmission population attributable fraction over time (tPAFt), on which our team has been examining data and methodological issues as well as implications of its use for programmes or policies. In this paper, we provide a conceptual framework for the design and interpretation of tPAFt. We propose that estimates could begin with three problem/objective statements: 1) who is at disproportionate risk of onward transmission; 2) under what prevention gaps; and 3) among whom are onward transmission counted and over what time period. For example, we could estimate a tPAFt to measure the contribution of unmet prevention needs (question 2) among female sex workers (FSW, question 1) to all new HIV infections of the total population over the next 10 years (question 3). We discuss the details of the three questions with examples of tPAFt estimates using published modeling results, followed by the implications of the results. We then conclude with a list of key properties of the tPAFt to aid in its interpretation.

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