Sub-Saharan Africa accounts for two thirds of the world’s HIV infections, and there have been substantial investments, from both international donors and African governments, in programmes to reduce HIV incidence and AIDS mortality. Mathematical models have played an important role in evaluating the impact of different prevention and treatment strategies in sub-Saharan Africa, in assessing which strategies are most cost-effective, and in influencing decisions about which programmes to prioritize. However, most mathematical models of HIV interventions have focused on proximate determinants of HIV risk (i.e. behavioural and biomedical risk factors) and associated interventions, such as antiretroviral treatment, HIV testing, pre-exposure prophylaxis, condom promotion and medical male circumcision. Few have considered the more distal determinants of HIV risk, such as gender inequality, poverty, and laws that criminalize commercial sex and same-sex relationships.
Although definitions vary, structural interventions can be broadly considered as interventions that alter the social, economic, legal and political environment that shapes health processes and outcomes. Social enablers tend to be defined more narrowly as social factors that affect uptake of health services. There is growing appreciation that structural interventions and interventions addressing social enablers may be critical to reducing HIV incidence, but evidence is weak and limited, as many structural interventions cannot be evaluated in individual-randomized experiments. There is also growing appreciation that in order for the HIV response to be sustained in the longer term, it needs to be more integrated into the current Sustainable Development Goals (SDG) framework, which emphasizes the structural factors that shape HIV risk. Funders are increasingly interested in quantifying the impact of these structural interventions.
Recognizing the growing interest in broadening the HIV response in sub-Saharan Africa, and the critical role that mathematical models can play in this regard, BMC Medicine and BMC Infectious Diseases come together to invite submissions of:
- Original research describing mathematical models of structural drivers of HIV incidence and AIDS mortality in sub-Saharan Africa, and interventions to address these drivers;
- Reviews of previously published models of structural interventions, with a focus on sub-Saharan Africa; and Commentaries on challenges associated with modelling and costing structural interventions, potentially with guidelines on how best to model structural interventions.
Image credit: National Cancer Institute/Unsplash
