We are working to understand the causes and consequences of heterogeneity in the risks of HIV/STI acquisition and transmission. Heterogeneity in risks may reflect variability in biology, individual-level behavior, partnership-level features and sexual networks, and structural pathways that interact and modify each of the former. Our goal is to creatively explore and disentangle the role of – and interactions between – various factors in establishing and sustaining HIV/STI epidemics. We work with different types of data and different types of statistical and mathematical models to answer our research questions.
Our work includes examining approaches to quantify the relative “contribution” of specific risk factors, or unmet needs (prevention and treatment gaps) across subsets of a population, to onward HIV/STI transmission in Sub-Saharan Africa. For example, we are conducting several projects related to the transmission population attributable fraction (tPAF), such as examining the determinants of the tPAF and how model structure and heterogeneity influence tPAF projections.
- Knight J, Baral SD, Schwartz S, Wang L, Ma H, Young K, Hausler H, Mishra S. (2020). Contribution of high risk groups’ unmet needs may be underestimated in epidemic models without risk turnover: a mechanistic modelling analysis. (Trainee publication). [Preprint available].
- Mishra S, Baral SD. (2019). Rethinking the population attributable fraction for infectious diseases. Lancet Infect Dis. Epub ahead of print. doi:10.1016/S1473-3099(19)30618-8.
- Mishra S, Boily MC, Shwartz S, Blanchard JF, Moses S, Vickerman P, Alary M, Baral SB. (2016). Data and methods to characterize the role of sex work and to inform sex work programs in generalized HIV epidemics: evidence to challenge assumptions. Ann Epidemiol, 26(8), 557-69. [PDF access]
- Boily MC, Pickles MC, Alary M, Baral S, Blanchard JF, Moses S, Vickerman P, Mishra S. (2015). What really is a concentrated HIV epidemic and what does it mean for West and Central Africa? Insights from modelling. J Acquir Immune Defic Syndr, 68, 74-82.
- Mishra S, Pickles M, Blanchard JF, Moses S, Shubber Z, Boily MC. (2014). Validation of the Modes of Transmission model as a tool to prioritize HIV prevention targets: a comparative modeling analysis. PLoS One, 9(7), e101690.
- Mishra S, Pickles M, Blanchard JF, Moses S, Boily MC. (2014). Distinguishing sources of HIV transmission from the distribution of newly acquired HIV infections: why is it important for HIV prevention planning? Sex Transm Infect, 90(1), 19-25. [PDF access]
Our work on heterogeneity in risks by age, sex work hotspots, and sexual networks include the CIHR-funded Transitions study. Transitions is an observational and mathematical modeling study co-led in partnership with Dr. Marissa Becker and the Centre for Global Public Health at the University of Manitoba, Kenya HIV Technical Support Unit, Government of Kenya National AIDS and STIs Control Programme, and the Ukranian Institute of Social Research. Examples of findings to date include:
- Ma H, Wang L, Gichangi P, Mochache V, Manguro G, Musyoki HK, Bhattacharjee P, Cholette F, Sandstrom P, Becker ML, Mishra S. (2019). Venue-based HIV testing at sex work hotspots to reach adolescent girls and young women living with HIV: a cross-sectional study in Mombasa, Kenya. J Acquir Immune Defic Syndr. Accepted. [Preprint available].
- Cheuk E, Isac S, Musyoki H, Pickles M, Bhattacharjee P, Gichangi P, Lorway R, Mishra S, Blanchard J, Becker M. (2019). Informing HIV prevention programs for adolescent girls and young women: a modified approach to programmatic mapping and key population size estimation. JMIR Public Health Surveill, 5(2), e11196.
- Becker ML, Bhattacharjee P, Blanchard JF, Cheuk E, Isac S, Musyoki HK, Gichangi P, Aral S, Pickles M, Sandstrom P, Ma H, Mishra S. (2018). Vulnerabilities at first sex and their association with lifetime gender-based violence and HIV prevalence among adolescent girls and young women engaged in sex work, transactional sex, and casual sex in Kenya. J Acquir Immune Defic Syndr, 79(3), 296-304.
The CIHR-funded Dynamics study examines the impact of political conflict in the dynamics of sex work and the HIV/STI and HCV epidemic in Ukraine. This study is conducted in collaboration with the Centre for Global Public Health at the University of Manitoba, Imperial College London, and the Ukrainian Institute for Social Research after Olexander Yaremenko. Examples of findings include:
Mishra Lab 