Application of mathematical modelling to determine the most optimal combinational strategy for controlling the spread of HIV/AIDS among sexually active adults in fishing communities around Lake Victoria in Uganda

Abstract

With an estimated 1.5 million new infections in 2021, HIV remains a major global health problem. In countries such as Uganda with mature generalized epidemics, there are still groups of individuals that are disproportionately affected by HIV. Among these Key populations in Uganda are fishing communities, which make up about 10% of the total population that is most at risk of being infected with the HIV virus. These fishing communities have high HIV incidence and prevalence compared to the general population. This high incidence and prevalence is attributed to several factors including limited access to prevention and treatment services, mobility of fisher mongers, demographic profile (they are often young and sexually active), as well as high risk sexual behavior. To determine the most optimum combinational control strategy for HIV/AIDS among sexually active men and women in fishing communities around Lake Victoria in Uganda using mathematical modeling. Empirical data on HIV/AIDS transmission in fishing communities was obtained from available literature and published research. The parameters were applied to a population- level, deterministic, compartmental model of heterosexual HIV transmission. This model was run using python software to assess the most optimum combinational control strategy to curb down the high incidences of HIV/AIDS in fishing communities. The control strategies that were considered include; HIV testing and counseling, early initiation of Anti-Retroviral therapy (Early ART), use of condoms, voluntary medical male circumcision and use of Prep. Models involving a combination of only two, three, four combinations at a time, and the full model with all interventions were considered. All parameters were assessed through sensitivity analysis using partial rank correlation coefficients (PRCCs) and Latin hypercube sampling because it helps to determine the full parameter space of a model with optimal number of computer simulations. The rate at which the susceptible individuals acquire HIV infection virus was the most sensitive model parameter and condom use was the most sensitive control intervention. Although the results show a high proportion of individuals with HIV, the incidence curve is indicative of a declining HIV infection and settling at an endemic steady state. The results are suggestive of the need to promote preventive mechanism against the occurrence of new infections. This study concludes that a combination of all complementary control mechanisms (HCT, Early ART, Condom Use, VMMC & Prep Use,) with consistently higher levels of condom usage as the most optimal combinational control strategy among sexually active people in fishing communities in Uganda.