Dynamic Partnerships and HIV Transmissions by Stage.

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dc.contributor.author Kim, Jong-Hoon en_US
dc.date.accessioned 2010-01-07T16:35:10Z
dc.date.available NO_RESTRICTION en_US
dc.date.available 2010-01-07T16:35:10Z
dc.date.issued 2009 en_US
dc.date.submitted en_US
dc.identifier.uri http://hdl.handle.net/2027.42/64804
dc.description.abstract Effectiveness of some control programs of human immunodeficiency virus (HIV) transmission depends on what proportion of new infections are attributable to a particular stage of HIV infection. Most model analyses for the transmission of HIV by stage have neglected real-world details such as sexual partnerships, risk fluctuation and sexual role segregation. To examine the effects of those real-world details on the transmission of HIV by stage, we constructed various models of HIV transmission using both individual-based and deterministic compartmental approaches. Transmissions through long-term sexual partnerships generate local network structure in which infected individuals are connected to fewer susceptible partners compared with the population average. The increasing depletion of susceptible partners around infected individuals monotonically decreases basic reproductive ratio and endemic prevalence of HIV infection with increasing partnership duration. The role of primary HIV infection (PHI), i.e., fractional contribution to basic reproductive ratio of PHI or the fraction of transmissions from PHI at endemic phase, has a U-shaped relationship with partnership duration. It drops in shorter partnerships, but rises in longer partnerships. This pattern is determined by the difference in relative depletion of susceptible partners by stage of infection. As the risk of transmission is made increasingly different by type of sex act while keeping the total population risk unchanged, endemic prevalence and the role of PHI become smaller. The decreased role of PHI is only observed when partnerships are long lasting. If individuals fluctuate between high- and low-risk phases, susceptible individuals are replenished from low- to high-risk phase and infection is spread from high- to low-risk phase. This increases endemic prevalence in the overall population. Risk fluctuation also causes individuals with PHI to be more likely to be in high-risk phase, which increases the role of PHI. Realistic details like sexual partnerships, sexual role segregation and risk fluctuation can strongly influence the transmission of HIV and do so differentially by stage of HIV infection. Model analyses intended to evaluate control program options or assess the role of a particular stage of infection need to take these details into account. en_US
dc.format.extent 10326125 bytes
dc.format.extent 1373 bytes
dc.format.mimetype application/pdf
dc.format.mimetype text/plain
dc.language.iso en_US en_US
dc.subject Human Immunodeficiency Virus, Sexual Partnerships, Networks, Pair Approximation, Individual-based Model en_US
dc.title Dynamic Partnerships and HIV Transmissions by Stage. en_US
dc.type Thesis en_US
dc.description.thesisdegreename Ph.D. en_US
dc.description.thesisdegreediscipline Epidemiological Science en_US
dc.description.thesisdegreegrantor University of Michigan, Horace H. Rackham School of Graduate Studies en_US
dc.contributor.committeemember Koopman, James S. en_US
dc.contributor.committeemember Diez Roux, Ana V. en_US
dc.contributor.committeemember Newman, Mark E. en_US
dc.contributor.committeemember Simon, Carl P. en_US
dc.contributor.committeemember Wilson, Mark L. en_US
dc.subject.hlbsecondlevel Public Health en_US
dc.subject.hlbtoplevel Health Sciences en_US
dc.description.bitstreamurl http://deepblue.lib.umich.edu/bitstream/2027.42/64804/1/jonghook_1.pdf
dc.owningcollname Dissertations and Theses (Ph.D. and Master's)
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