Optimal control and cost-effectiveness analysis of Fasciola hepatica model.

A deterministic model with an optimal control framework is formulated to analyse the cost-effectiveness of intervention measures used to control Fasciola hepatica in cattle populations. Using the Volterra-Lyapunov stability method, it is noted that the model is globally stable at the endemic equilibrium point. The Pontryagin maximum principle has been applied to determine optimal disease control conditions, including strategies such as pasture management, treatment of infected cattle, and molluscicide use. Numerical simulations for the optimum problem show that double and triple controls have significant effects on reducing disease transmission. The results indicate that for optimal impact, the molluscicide control parameter should always be at its highest possible value. The incremental cost-effectiveness ratio (ICER) analysis of strategies to reduce the disease shows that pasture management combined with molluscicide use will be the most effective and least expensive option. The molluscicide intervention rate should always be at its maximum value for better control of the disease. Educational programs for proper pasture management conditions and sufficient use of molluscicides can significantly reduce the spread of Fasciola hepatica among cattle and humans.

The role of backward mutations on the within-host dynamics of HIV-1.

The quality of life for patients infected with human immunodeficiency virus (HIV-1) has been positively impacted by the use of antiretroviral therapy (ART). However, the benefits of ART are usually halted by the emergence of drug resistance. Drug-resistant strains arise from virus mutations, as HIV-1 reverse transcription is prone to errors, with mutations normally carrying fitness costs to the virus. When ART is interrupted, the wild-type drug-sensitive strain rapidly out-competes the resistant strain, as the former strain is fitter than the latter in the absence of ART. One mechanism for sustaining the sensitive strain during ART is given by the virus mutating from resistant to sensitive strains, which is referred to as backward mutation. This is important during periods of treatment interruptions as prior existence of the sensitive strain would lead to replacement of the resistant strain. In order to assess the role of backward mutations in the dynamics of HIV-1 within an infected host, we analyze a mathematical model of two interacting virus strains in either absence or presence of ART. We study the effect of backward mutations on the definition of the basic reproductive number, and the value and stability of equilibrium points. The analysis of the model shows that, thanks to both forward and backward mutations, sensitive and resistant strains co-exist. In addition, conditions for the dominance of a viral strain with or without ART are provided. For this model, backward mutations are shown to be necessary for the persistence of the sensitive strain during ART.

Determining the effects of wind-aided midge movement on the outbreak and coexistence of multiple bluetongue virus serotypes in patchy environments.

Bluetongue virus (BTV) has 27 serotypes with some of them coexisting in different environments which make its control difficult. Wind-aided midge movement is a known mechanism in the spread of BTV. However, its effects on the dynamics of multiple BTV serotypes are not clear. Ordinary differential equation (ODE) and continuous-time Markov chain (CTMC) models for two BTV serotypes in an environment divided into two patches depending on the risk of infection are formulated and analysed. By approximating the CTMC model with a multitype branching process, an estimate for the probability of a major outbreak of two BTV serotypes is obtained. It is shown that without movement a major outbreak occurs in the high-risk patch, but with cattle or midge movement it occurs in both patches. When a major outbreak occurs, numerical simulations of the ODE model illustrate possible coexistence in both patches if the patches are connected by midge or cattle movement. Sensitivity analysis, based on the Latin hypercube sampling method, identified midge mortality and biting rates as being the most important in determining the magnitude of the probability of a major outbreak. These results indicate the significance of wind-aided midge movement on the outbreak and coexistence of multiple BTV serotypes in patchy environments.

Mathematical modeling of COVID-19 transmission dynamics in Uganda: Implications of complacency and early easing of lockdown.

BACKGROUND: Uganda has a unique set up comprised of resource-constrained economy, social-economic challenges, politically diverse regional neighborhood and home to long-standing refuge crisis that comes from long and protracted conflicts of the great lakes. The devastation of the on-going global pandemic outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to be escalated by these circumstances with expectations of the impact of the disease being severe. MATERIALS AND METHODS: In this study, we formulate a mathematical model that incorporates the currently known disease characteristics and tracks various intervention measures that the government of Uganda has implemented since the reporting of the first case in March 2020. We then evaluate these measures to understand levels of responsiveness and adherence to standard operating procedures and quantify their impact on the disease burden. Novel in this model was the unique aspect of modeling the trace-and-isolate protocol in which some of the latently infected individuals tested positive while in strict isolation centers thereby reducing their infectious period. RESULTS: The study findings show that even with elimination of all imported cases at any given time it would take up to nine months to rid Uganda of the disease. The findings also show that the optimal timing of easing of lockdowns while mitigating the possibility of re-emergence of a second epidemic wave requires avoiding the scenario of releasing too-many-too-soon. It is even more worrying that enhancing contact tracing would only affect the magnitude and timing of the second wave but cannot prevent it altogether. CONCLUSION: We conclude that, given the prevailing circumstances, a phased-out lifting of lockdown measures, minimization of COVID-19 transmissibility within hospital settings, elimination of recruitment of infected individuals as well as enhanced contact tracing would be key to preventing overwhelming of the healthcare system that would come with dire consequences.

Modelling hepatotoxicity and antiretroviral therapeutic effect in HIV/HBV coinfection.

Enzyme alanine aminotransferase (ALT) elevation which reflects hepatocellular injury is a current challenge in people infected with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). One of the factors that enhance the risk of hepatotoxicity is underlying diseases such as hepatitis caused by hepatitis B virus (HBV). HIV/HBV coinfected patients stand a greater risk of hepatotoxicity because all ART are toxic and liver cells (hepatocytes) that are responsible for metabolising the toxic ART, support all stages of HIV and HBV viral production. Mathematical models coupled with numerical simulations are used in this study with the aim of investigating the optimal combination of ART in HIV/HBV coinfection. Emtricitabine, tenofovir and efavirenz is the optimal combination that maximises the therapeutic effect of therapy and minimises the toxic response to medication in HIV/HBV coinfection.

Mathematical modeling of liver enzyme elevation in HIV mono-infection.

HIV-infected individuals are increasingly becoming susceptible to liver disease and, hence, liver-related mortality is on a rise. The presence of CD4+ in the liver and the presence of C-X-C chemokine receptor type 4 (CXCR4) on human hepatocytes provide a conducive environment for HIV invasion. In this study, a mathematical model is used to analyse the dynamics of HIV in the liver with the aim of investigating the existence of liver enzyme elevation in HIV mono-infected individuals. In the presence of HIV-specific cytotoxic T-lymphocytes, the model depicts a unique endemic equilibrium with a transcritical bifurcation when the basic reproductive number is unity. Results of the study show that the level of liver enzyme alanine aminotransferase (ALT) increases with increase in the rate of hepatocytes production. Numerical simulations reveal significant elevation of alanine aminotransferase with increase in viral load. The findings presuppose that while liver damage in HIV infection has mostly been associated with HIV/HBV coinfection and use of antiretroviral therapy (ART), it is possible to have liver damage solely with HIV infection.

The dynamics, causes and possible prevention of Hepatitis E outbreaks.

Rapidly spreading infectious diseases are a serious risk to public health. The dynamics and the factors causing outbreaks of these diseases can be better understood using mathematical models, which are fit to data. Here we investigate the dynamics of a Hepatitis E outbreak in the Kitgum region of northern Uganda during 2007 to 2009. First, we use the data to determine that R0 is approximately 2.25 for the outbreak. Secondly, we use a model to estimate that the critical level of latrine and bore hole coverages needed to eradicate the epidemic is at least 16% and 17% respectively. Lastly, we further investigate the relationship between the co-infection factor for malaria and Hepatitis E on the value of R0 for Hepatitis E. Taken together, these results provide us with a better understanding of the dynamics and possible causes of Hepatitis E outbreaks.