Modeling HIV/AIDS and Tuberculosis Coinfection

An HIV/AIDS and TB coinfection model which considers antiretroviral therapy for the AIDS cases and treatment of all forms of TB, i.e., latent and active forms of TB, is presented. We begin by presenting an HIV/AIDS-TB coinfection model and analyze the TB and HIV/AIDS submodels separately without any intervention strategy. The TB-only model is shown to exhibit backward bifurcation when its corresponding reproduction number is less than unity. On the other hand, the HIV/AIDS-only model has a globally asymptotically stable disease-free equilibrium when its corresponding reproduction number is less than unity. We proceed to analyze the full HIV-TB coinfection model and extend the model to incorporate antiretroviral therapy for the AIDS cases and treatment of active and latent forms of TB. The thresholds and equilibria quantities for the models are determined and stabilities analyzed. From the study we conclude that treatment of AIDS cases results in a significant reductions of numbers of individuals progressing to active TB. Further, treatment of latent and active forms of TB results in delayed onset of the AIDS stage of HIV infection.     

Global dynamics of a staged-progression model with amelioration for infectious diseases

We analyze the global dynamics of a mathematical model for infectious diseases that progress through distinct stages within infected hosts with possibility of amelioration. An example of such diseases is HIV/AIDS that progresses through several stages with varying degrees of infectivity; amelioration can result from a host's immune action or more commonly from antiretroviral therapies, such as highly active antiretroviral therapy. For a general n-stage model with constant recruitment and bilinear incidence that incorporates amelioration, we prove that the global dynamics are completely determined by the basic reproduction number R(0). If R(0)≤1, then the disease-free equilibrium P(0) is globally asymptotically stable, and the disease always dies out. If R(0)>1, P(0) is unstable, a unique endemic equilibrium P* is globally asymptotically stable, and the disease persists at the endemic equilibrium. Impacts of amelioration on the basic reproduction number are also investigated.     

Malaria Drug Resistance: The Impact of Human Movement and Spatial Heterogeneity

Human habitat connectivity, movement rates, and spatial heterogeneity have tremendous impact on malaria transmission. In this paper, a deterministic system of differential equations for malaria transmission incorporating human movements and the development of drug resistance malaria in an \(n\) patch system is presented. The disease-free equilibrium of the model is globally asymptotically stable when the associated reproduction number is less than unity. For a two patch case, the boundary equilibria (drug sensitive-only and drug resistance-only boundary equilibria) when there is no movement between the patches are shown to be locally asymptotically stable when they exist; the co-existence equilibrium is locally asymptotically stable whenever the reproduction number for the drug sensitive malaria is greater than the reproduction number for the resistance malaria. Furthermore, numerical simulations of the connected two patch model (when there is movement between the patches) suggest that co-existence or competitive exclusion of the two strains can occur when the respective reproduction numbers of the two strains exceed unity. With slow movement (or low migration) between the patches, the drug sensitive strain dominates the drug resistance strain. However, with fast movement (or high migration) between the patches, the drug resistance strain dominates the drug sensitive strain.     

Dynamical analysis of a multi-strain model of HIV in the presence of anti-retroviral drugs

One major drawback associated with the use of anti-retroviral drugs in curtailing HIV spread in a population is the emergence and transmission of HIV strains that are resistant to these drugs. This paper presents a deterministic HIV treatment model, which incorporates a wild (drug sensitive) and a drug-resistant strain, for gaining insights into the dynamical features of the two strains, and determining effective ways to control HIV spread under this situation. Rigorous qualitative analysis of the model reveals that it has a globally asymptotically stable disease-free equilibrium whenever a certain epidemiological threshold (R t 0) is less than unity and that the disease will persist in the population when this threshold exceeds unity. Further, for the case where R t 0 > 1, it is shown that the model can have two co-existing endemic equilibria, and competitive exclusion phenomenon occurs whenever the associated reproduction number of the resistant strain (R t r) is greater than that of the wild strain (R t w). Unlike in the treatment model, it is shown that the model without treatment can have a family of infinitely many endemic equilibria when its associated epidemiological threshold (R(0)) exceeds unity. For the case when [Formula in text], it is shown that the widespread use of treatment against the wild strain can lead to its elimination from the community if the associated reduction in infectiousness of infected individuals (treated for the wild strain) does not exceed a certain threshold value (in this case, the use of treatment is expected to make R t w < R t r.     

Linking immunological and epidemiological dynamics of HIV: the case of super-infection

In this paper, a two-strain model that links immunological and epidemiological dynamics across scales is formulated. On the within-host scale, the two strains eliminate each other with the strain with the larger immunological reproduction persisting. However, on the population scale superinfection is possible, with the strain with larger immunological reproduction number super-infecting the strain with the smaller immunological reproduction number. The two models are linked through the age-since-infection structure of the epidemiological variables. In addition, the between-host transmission and the disease-induced death rate depend on the within-host viral load. The immunological reproduction numbers, the epidemiological reproduction numbers and invasion reproduction numbers are computed. Besides the disease-free equilibrium, there are two population-level strain one and strain two isolated equilibria, as well as a population-level coexistence equilibrium when both invasion reproduction numbers are greater than one. The single-strain population-level equilibria are locally asymptotically stable suggesting that in the absence of superinfection oscillations do not occur, a result contrasting previous studies of HIV age-since-infection structured models. Simulations suggest that the epidemiological reproduction number and HIV population prevalence are monotone functions of the within-host parameters with reciprocal trends. In particular, HIV medications that decrease within-host viral load also increase overall population prevalence. The effect of the immunological parameters on the population reproduction number and prevalence is more pronounced when the initial viral load is lower.     

Modelling the effects of pre-exposure and post-exposure vaccines in tuberculosis control

Epidemic control strategies alter the spread of the disease in the host population. In this paper, we describe and discuss mathematical models that can be used to explore the potential of pre-exposure and post-exposure vaccines currently under development in the control of tuberculosis. A model with bacille Calmette-Guerin (BCG) vaccination for the susceptibles and treatment for the infectives is first presented. The epidemic thresholds known as the basic reproduction numbers and equilibria for the models are determined and stabilities are investigated. The reproduction numbers for the models are compared to assess the impact of the vaccines currently under development. The centre manifold theory is used to show the existence of backward bifurcation when the associated reproduction number is less than unity and that the unique endemic equilibrium is locally asymptotically stable when the associated reproduction number is greater than unity. From the study we conclude that the pre-exposure vaccine currently under development coupled with chemoprophylaxis for the latently infected and treatment of infectives is more effective when compared to the post-exposure vaccine currently under development for the latently infected coupled with treatment of the infectives.     

Chancroid transmission dynamics: a mathematical modeling approach

Mathematical models have long been used to better understand disease transmission dynamics and how to effectively control them. Here, a chancroid infection model is presented and analyzed. The disease-free equilibrium is shown to be globally asymptotically stable when the reproduction number is less than unity. High levels of treatment are shown to reduce the reproduction number suggesting that treatment has the potential to control chancroid infections in any given community. This result is also supported by numerical simulations which show a decline in chancroid cases whenever the reproduction number is less than unity.     

Global Stability of Equilibria in a Two-Sex HPV Vaccination Model

Human papillomavirus (HPV) is the primary cause of cervical carcinoma and its precursor lesions, and is associated with a variety of other cancers and diseases. A prophylactic quadrivalent vaccine against oncogenic HPV 16/18 and warts-causing genital HPV 6/11 types is currently available in several countries. Licensure of a bivalent vaccine against oncogenic HPV 16/18 is expected in the near future. This paper presents a two-sex, deterministic model for assessing the potential impact of a prophylactic HPV vaccine with several properties. The model is based on the susceptible-infective-removed (SIR) compartmental structure. Important epidemiological thresholds such as the basic and effective reproduction numbers and a measure of vaccine impact are derived. We find that if the effective reproduction number is greater than unity, there is a locally unstable infection-free equilibrium and a unique, globally asymptotically stable endemic equilibrium. If the effective reproduction number is less than unity, the infection-free equilibrium is globally asymptotically stable, and HPV will be eliminated.     

The role of screening and treatment in the transmission dynamics of HIV/AIDS and tuberculosis co-infection: a mathematical study

In this paper, we present a deterministic non-linear mathematical model for the transmission dynamics of HIV and TB co-infection and analyze it in the presence of screening and treatment. The equilibria of the model are computed and stability of these equilibria is discussed. The basic reproduction numbers corresponding to both HIV and TB are found and we show that the disease-free equilibrium is stable only when the basic reproduction numbers for both the diseases are less than one. When both the reproduction numbers are greater than one, the co-infection equilibrium point may exist. The co-infection equilibrium is found to be locally stable whenever it exists. The TB-only and HIV-only equilibria are locally asymptotically stable under some restriction on parameters. We present numerical simulation results to support the analytical findings. We observe that screening with proper counseling of HIV infectives results in a significant reduction of the number of individuals progressing to HIV. Additionally, the screening of TB reduces the infection prevalence of TB disease. The results reported in this paper clearly indicate that proper screening and counseling can check the spread of HIV and TB diseases and effective control strategies can be formulated around ‘screening with proper counseling’.     

On the dynamics of SEIRS epidemic model with transport-related infection

Transportation amongst cities is found as one of the main factors which affect the outbreak of diseases. To understand the effect of transport-related infection on disease spread, an SEIRS (Susceptible, Exposed, Infectious, Recovered) epidemic model for two cities is formulated and analyzed. The epidemiological threshold, known as the basic reproduction number, of the model is derived. If the basic reproduction number is below unity, the disease-free equilibrium is locally asymptotically stable. Thus, the disease can be eradicated from the community. There exists an endemic equilibrium which is locally asymptotically stable if the reproduction number is larger than unity. This means that the disease will persist within the community. The results show that transportation among regions will change the disease dynamics and break infection out even if infectious diseases will go to extinction in each isolated region without transport-related infection. In addition, the result shows that transport-related infection intensifies the disease spread if infectious diseases break out to cause an endemic situation in each region, in the sense of that both the absolute and relative size of patients increase. Further, the formulated model is applied to the real data of SARS outbreak in 2003 to study the transmission of disease during the movement between two regions. The results show that the transport-related infection is effected to the number of infected individuals and the duration of outbreak in such the way that the disease becomes more endemic due to the movement between two cities. This study can be helpful in providing the information to public health authorities and policy maker to reduce spreading disease when its occurs.     

Mathematical Study of a Staged-Progression HIV Model with Imperfect Vaccine

A staged-progression HIV model is formulated and used to investigate the potential impact of an imperfect vaccine. The vaccine is assumed to have several desirable characteristics such as protecting against infection, causing bypass of the primary infection stage, and offering a disease-altering therapeutic effect (so that the vaccine induces reversal from the full blown AIDS stage to the asymptomatic stage). The model, which incorporates HIV transmission by individuals in the AIDS stage, is rigorously analyzed to gain insight into its qualitative features. Using a comparison theorem, the model with mass action incidence is shown to have a globally-asymptotically stable disease-free equilibrium whenever a certain threshold, known as the vaccination reproduction number, is less than unity. Furthermore, the model with mass action incidence has a unique endemic equilibrium whenever this threshold exceeds unity. Using the Li-Muldowney techniques for a reduced version of the mass action model, this endemic equilibrium is shown to be globally-asymptotically stable, under certain parameter restrictions. The epidemiological implications of these results are that an imperfect vaccine can eliminate HIV in a given community if it can reduce the reproduction number to a value less than unity, but the disease will persist otherwise. Furthermore, a future HIV vaccine that induces the bypass of primary infection amongst vaccinated individuals (who become infected) would decrease HIV prevalence, whereas a vaccine with therapeutic effect could have a positive or negative effect at the community level.     

An age-structured within-host HIV-1 infection model with virus-to-cell and cell-to-cell transmissions

In this paper, a within-host HIV-1 infection model with virus-to-cell and direct cell-to-cell transmission and explicit age-since-infection structure for infected cells is investigated. It is shown that the model demonstrates a global threshold dynamics, fully described by the basic reproduction number. By analysing the corresponding characteristic equations, the local stability of an infection-free steady state and a chronic-infection steady state of the model is established. By using the persistence theory in infinite dimensional system, the uniform persistence of the system is established when the basic reproduction number is greater than unity. By means of suitable Lyapunov functionals and LaSalle's invariance principle, it is shown that if the basic reproduction number is less than unity, the infection-free steady state is globally asymptotically stable; if the basic reproduction number is greater than unity, the chronic-infection steady state is globally asymptotically stable. Numerical simulations are carried out to illustrate the feasibility of the theoretical results.     

Global dynamics of an epidemiological model with age of infection and disease relapse

In this paper, an epidemiological model with age of infection and disease relapse is investigated. The basic reproduction number for the model is identified, and it is shown to be a sharp threshold to completely determine the global dynamics of the model. By analysing the corresponding characteristic equations, the local stability of a disease-free steady state and an endemic steady state of the model is established. By means of suitable Lyapunov functionals and LaSalle's invariance principle, it is verified that if the basic reproduction number is less than unity, the disease-free steady state is globally asymptotically stable, and hence the disease dies out; if the basic reproduction number is greater than unity, the endemic steady state is globally asymptotically stable and the disease becomes endemic.     

An SIR pairwise epidemic model with infection age and demography

The demography and infection age play an important role in the spread of slowly progressive diseases. To investigate their effects on the disease spreading, we propose a pairwise epidemic model with infection age and demography on dynamic networks. The basic reproduction number of this model is derived. It is proved that there is a disease-free equilibrium which is globally asymptotically stable if the basic reproduction number is less that unity. Besides, sensitivity analysis is performed and shows that increasing the variance in recovery time and decreasing the variance in infection time can effectively control the diseases. The complex interaction between the death rate and equilibrium prevalence suggests that it is imperative to correctly estimate the parameters of demography in order to assess the disease transmission dynamics accurately. Moreover, numerical simulations show that the endemic equilibrium is globally asymptotically stable.     

Spread of disease with transport-related infection and entry screening

An SIQS model is proposed to study the effect of transport-related infection and entry screening. If the basic reproduction number is below unity, the disease free equilibrium is locally asymptotically stable. There exists an endemic equilibrium which is locally asymptotically stable if the reproduction number is larger than unity. It is shown that the disease is endemic in the sense of permanence if and only if the endemic equilibrium exists. Entry screening is shown to be helpful for disease eradication since it can always have the possibility to eradicate the disease led by transport-related infection and furthermore have the possibility to eradicate disease even when the disease is endemic in both isolated cities.     

Modelling the Transmission Dynamics and Control of the Novel 2009 Swine Influenza (H1N1) Pandemic

The paper presents a deterministic compartmental model for the transmission dynamics of swine influenza (H1N1) pandemic in a population in the presence of an imperfect vaccine and use of drug therapy for confirmed cases. Rigorous analysis of the model, which stratifies the infected population in terms of their risk of developing severe illness, reveals that it exhibits a vaccine-induced backward bifurcation when the associated reproduction number is less than unity. The epidemiological consequence of this result is that the effective control of H1N1, when the reproduction number is less than unity, in the population would then be dependent on the initial sizes of the subpopulations of the model. For the case where the vaccine is perfect, it is shown that having the reproduction number less than unity is necessary and sufficient for effective control of H1N1 in the population (in such a case, the associated disease-free equilibrium is globally asymptotically stable). The model has a unique endemic equilibrium when the reproduction number exceeds unity. Numerical simulations of the model, using data relevant to the province of Manitoba, Canada, show that it reasonably mimics the observed H1N1 pandemic data for Manitoba during the first (Spring) wave of the pandemic. Further, it is shown that the timely implementation of a mass vaccination program together with the size of the Manitoban population that have preexisting infection-acquired immunity (from the first wave) are crucial to the magnitude of the expected burden of disease associated with the second wave of the H1N1 pandemic. With an estimated vaccine efficacy of approximately 80%, it is projected that at least 60% of Manitobans need to be vaccinated in order for the effective control or elimination of the H1N1 pandemic in the province to be feasible. Finally, it is shown that the burden of the second wave of H1N1 is expected to be at least three times that of the first wave, and that the second wave would last until the end of January or early February, 2010.     

Mathematical Analysis of the Transmission Dynamics of HIV Syphilis Co-infection in the Presence of Treatment for Syphilis

The re-emergence of syphilis has become a global public health issue, and more persons are getting infected, especially in developing countries. This has also led to an increase in the incidence of human immunodeficiency virus (HIV) infections as some studies have shown in the recent decade. This paper investigates the synergistic interaction between HIV and syphilis using a mathematical model that assesses the impact of syphilis treatment on the dynamics of syphilis and HIV co-infection in a human population where HIV treatment is not readily available or accessible to HIV-infected individuals. In the absence of HIV, the syphilis-only model undergoes the phenomenon of backward bifurcation when the associated reproduction number (\({\mathcal {R}}_{T}\)) is less than unity, due to susceptibility to syphilis reinfection after recovery from a previous infection. The complete syphilis–HIV co-infection model also undergoes the phenomenon of backward bifurcation when the associated effective reproduction number (\({\mathcal {R}}_{C}\)) is less than unity for the same reason as the syphilis-only model. When susceptibility to syphilis reinfection after treatment is insignificant, the disease-free equilibrium of the syphilis-only model is shown to be globally asymptotically stable whenever the associated reproduction number (\({\mathcal {R}}_{T}\)) is less than unity. Sensitivity and uncertainty analysis show that the top three parameters that drive the syphilis infection (with respect to the associated response function, \({\mathcal {R}}_{T}\)) are the contact rate (\(\beta _S\)), modification parameter that accounts for the increased infectiousness of syphilis-infected individuals in the secondary stage of the infection (\(\theta _1\)) and treatment rate for syphilis-only infected individuals in the primary stage of the infection (\(r_1\)). The co-infection model was numerically simulated to investigate the impact of various treatment strategies for primary and secondary syphilis, in both singly and dually infected individuals, on the dynamics of the co-infection of syphilis and HIV. It is observed that if concerted effort is exerted in the treatment of primary and secondary syphilis (in both singly and dually infected individuals), especially with high treatment rates for primary syphilis, this will result in a reduction in the incidence of HIV (and its co-infection with syphilis) in the population.     

On a Reproductive Stage-Structured Model for the Population Dynamics of the Malaria Vector

A reproductive stage-structured deterministic differential equation model for the population dynamics of the human malaria vector is derived and analysed. The model captures the gonotrophic and behavioural life characteristics of the female Anopheles sp. mosquito and takes into consideration the fact that for the purposes of reproduction, the female Anopheles sp. mosquito must visit and bite humans (or animals) to harvest necessary proteins from blood that it needs for the development of its eggs. Focusing on mosquitoes that feed exclusively on humans, our results indicate the existence of a threshold parameter, the vectorial reproduction number, whose size increases with increasing number of gonotrophic cycles, and is also affected by the female mosquito’s birth rate, its attraction and visitation rate to human residences, and its contact rate with humans. A stability analysis of the model indicates that the mosquito can establish itself in the environment if and only if the value of the vectorial reproduction number exceeds unity and that mosquito eradication is possible if the vectorial reproduction number is less than unity, since, then, the trivial steady state which always exist is unique and is globally and asymptotically stable. When a persistent vector population steady state exists, it is locally and asymptotically stable for a range of reproduction numbers, but can also be driven to instability via a Hopf bifurcation as the reproduction number increases further away from unity. The model derivation identifies and characterizes control parameters relating to activities such as human-mosquito contact and the mosquito’s survival chances between blood meals and egg laying. Our results show that the total mosquito population size increases with increasing number of gonotrophic cycles. Therefore understanding the fundamental aspects of the mosquito’s behaviour provides a pathway for the study of human-mosquito contact and mosquito population control. Control of the mosquito population densities would ultimately lead to malaria control.     

Mathematical model for Zika virus dynamics with sexual transmission route

Zika virus is a flavivirus transmitted to humans primarily through the bite of infected Aedes mosquitoes. In addition to vector-borne spread, however, the virus can also be transmitted through sexual contact. In this paper, we formulate and analyze a new system of ordinary differential equations which incorporates both vector and sexual transmission routes. Theoretical analysis of this model when there is no disease induced mortality shows that the disease-free equilibrium is locally and globally asymptotically stable whenever the associated reproduction number is less than unity and unstable otherwise. However, when we extend this same model to include Zika induced mortality, which have been documented in Latin America, we find that the model exhibits a backward bifurcation. Specifically, a stable disease-free equilibrium co-exists with a stable endemic equilibrium when the associated reproduction number is less than unity. To further explore model predictions, we use numerical simulations to assess the importance of sexual transmission to disease dynamics. This analysis shows that risky behavior involving multiple sexual partners, particularly among male populations, substantially increases the number of infected individuals in the population, contributing significantly to the disease burden in the community.     

Modelling Hospitalization,Home-Based Care,and Individual Withdrawal for People Living with HIV/AIDS in High Prevalence Settings

In sub-Saharan Africa, the model of care for people who are living with HIV/AIDS has changed from hospital care to home-based care. In this paper, a mathematical model describing the dynamics of HIV transmission, hospitalization, and home-based care is constructed and analysed. The model reproduction number R _e is determined and discussed. The equilibria are determined and analysed in terms of R _e . It is shown that if R _e <1, the disease free equilibrium is both locally and globally asymptotically stable. The model has a unique endemic equilibrium and is locally asymptotically stable whenever R _e >1. Five cases arise in the discussion of R _e pertaining to intervention strategies. Numerical simulations are done to compare the impact of each strategy on the dynamics of HIV/AIDS. The model is fitted to the prevalence data estimates from UNAIDS on Zimbabwe. The implications of some key epidemiological parameters are investigated numerically. Projections are made to determine the possible long term trends of the prevalence of HIV in Zimbabwe.