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docs: api: clean up intro, related: #3, #5
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jessexknight committed Nov 24, 2021
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Expand Up @@ -3,18 +3,11 @@ \section{Introduction}
As of 2019, two thirds (25.7 million) of all people living with HIV globally
were in Sub-Saharan Africa (SSA), where
an estimated one million new HIV infections were acquired in 2019 \cite{AIDSinfo}.
Data suggest that key populations, including individuals engaged in sex work and men who have sex with men,
experience disproportionate risks of HIV acquisition and onward transmission in SSA
\cite{Baral2012,Beyrer2012,Mishra2012,Boily2015}.
HIV treatment to reduce onward transmission remains a key element of combination HIV prevention \cite{WHO2016ART}.
Effective HIV treatment with antiretroviral therapy (ART) leads to viral load suppression
and has been shown to prevent HIV transmission between sex partners \cite{Lundgren2015,Danel2015,Cohen2016}.
\par
Following empirical evidence of partnership-level efficacy of ART
in preventing HIV \cite{Lundgren2015,Danel2015,Cohen2016},
in preventing HIV transmission \cite{Lundgren2015,Danel2015,Cohen2016},
and model-based evidence of ``treatment as prevention'' \cite{Granich2009,Eaton2012,Cori2014},
several large-scale community-based trials of universal test-and-treat (UTT)
were recently completed \cite{Iwuji2018,Havlir2019,Hayes2019}.
several large-scale community-based trials of universal test-and-treat (UTT) were recently completed.
These trials found that over 2-to-4 years,
cumulative incidence under UTT did not significantly differ from
cumulative incidence under ART according to national guidelines \cite{Havlir2019,Hayes2019,Iwuji2018}.
Expand All @@ -28,11 +21,18 @@ \section{Introduction}
21--54\% of study participants remained unsuppressed \cite{Iwuji2018,Havlir2019,Hayes2019}.
Populations experiencing barriers to viral suppression under UTT
may be at highest risk for acquisition and onward transmission, including key populations like
sex workers and men who have sex with men \cite{Hakim2018,Nyato2019},
as well as youth, and heterosexual men \cite{Green2020,Quinn2019}.
sex workers and men who have sex with men \cite{Hakim2018,Nyato2019}.
Other sub-populations, including youth and heterosexual men, also
experience barriers to engagement in ART care \cite{Green2020,Quinn2019}
that could undermine treatment as prevention.
While widespread UTT scale-up may fill some coverage gaps,
equitable access to ART for all populations remains an open challenge.
\par
Risk heterogeneity, defined by various factors affecting acquisition and onward transmission risk,
is a well-established determinant of epidemic persistence and controllability
with a basis in the modelling literature \cite{Anderson1986,Boily1997}.
Model comparison studies by \citet{Hontelez2013} and \citet{Rozhnova2016}
found that projected prevention impacts of ART scale-up were smaller with greater heterogeneity.
Given the upstream and complementary role of transmission modelling
in estimating the prevention impacts of ART \cite{Eaton2012,Delva2012},
we sought to examine how heterogeneity in risk and ART uptake has been represented
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