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Modelling in concentrated epidemics: informing epidemic trajectories and assessing prevention approaches

Boily, Marie-Claude; Shubber, Zara

Current Opinion in HIV and AIDS: March 2014 - Volume 9 - Issue 2 - p 134–149
doi: 10.1097/COH.0000000000000036
EPIDEMIOLOGY: CONCENTRATED EPIDEMICS: Edited by Chris Beyrer, Stefan D. Baral, and Patrick S. Sullivan

Purpose of the review This review summarizes recent mathematical modelling studies conducted among key populations including MSM, people who inject drugs (PWID), and female sex workers (FSWs) in low prevalence settings used as a marker of concentrated epidemics.

Recent findings Most recent studies focused on MSM, Asian settings or high-income countries, studied the transmission dynamics or modelled pre-exposure prophylaxis, treatment as prevention or behavioural interventions specific to each key population (e.g., needle exchange programme or use of low-dead space syringes for PWID). Biological interventions were deemed effective and cost-effective, though still expensive, and often deemed unlikely to result in HIV elimination if used alone. Targeting high-risk individuals even within key populations improved efficiency. Some studies made innovative use of models to formally evaluate HIV prevention programmes, to interpret genetic or co-infection data, and to address methodological questions and validate epidemiological tools.

Conclusion More work is needed to optimize combination prevention focusing on key populations in different settings. The gaps identified include the limited number of studies modelling drug resistance, structural interventions, treatment as prevention among FSWs, and estimating the contribution of key populations to overall transmission in different settings.

Department of Infectious Diseases Epidemiology, Imperial College London, Norfolk Square, London W2 1PG, UK

Correspondence to Marie-Claude Boily, Department of Infectious Diseases Epidemiology, Imperial College London, Norfolk Square, London W2 1PG, UK. Tel: +44 207 288 0787; e-mail:

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.