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e-ISSN: 2278-5728, p-ISSN: 2319-765X. Volume 11, Issue 6 Ver. IV (Nov. - Dec. 2015), PP 33-43

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co infection model of HIV/AIDS, Tuberculosis and malaria.

Mark O. Okongo.

Physical Sciences, Chuka University, Kenya

Abstract: This study presents a co infection deterministic model defined by a system of ordinary

differential equations for HIV/AIDS, malaria and tuberculosis. The model is analyzed to determine

the conditions for the stability of the equilibria points and investigate the possibility of backward

bifurcation. The study shows that the local disease free equilibrium is stable when the reproduction

number is less than unity but the global stability of the disease free equilibrium is not guaranteed. The

model exhibits the phenomenon of backward bifurcation which posses a challenge to the design of

effective control measures.

Keywords: Bifurcation, Counseling, HIV/AIDS - TB and Malaria, Stability,Treatment.

I.

The basic reproduction number

Introduction

infectious individual would cause over his infectious period in an entirely susceptible population. When

R0 <

1, then an infectious individual is causing, on average, less than one new infection and thus the disease

does not invade the population. On the other hand, when R0 > 1 then an infectious individual is causing, on

average, more than one new infection and thus the disease invades and persist in the population. HIV/AIDS

remains one of the leading causes of death in the world with its effects most devastating in sub Saharan Africa.

One of the key factors that fuels the high incidence of HIV/AIDS in Sub Saharan Africa is its dual infection

with malaria and tuberculosis [16]. Audu et al. [4] investigated the possible impact of co infections of

tuberculosis and malaria on the CD4+ cell counts of HIV/AIDS patients and established the following: The

healthy control group recorded a median CD4+ cell counts of 789 cells/ul (789 cells per mm3 of blood); subjects

infected with HIV/AIDS only recorded a median CD4+ cell counts of 386 cell/ul; subjects co infected

with HIV/AIDS and TB recorded a median CD4+ cell counts of 268 cell/ul; subjects co infected with IV/AIDS

and malaria recorded a median CD4+ cell counts of 211 cell/ul and those co infected with HIV/AIDS, malaria

and TB recorded the lowest median CD4+ cell counts of 182 cell/ul. Motivated by these findings, a

deterministic model exploring the joint dynamics of the simultaneous co infections of HIV/AIDS, TB and

malaria incorporating treatment and counseling is presented and analysed for stability.

II.

To study the dynamics of HIV/AIDS, malaria and TB co infection, a deterministic model is formulated

described by a system of ordinary differential equations. The model sub-divide the human population into the

following epidemiological classes: SH(t) - Susceptible population at time t, IM(t) - Malaria infectives at time t,

IH(t) - HIV cases at time t, IA(t) - AIDS cases at time t, IT(t) - TB cases at time t. IHM(t) - Those co infected with

malaria and HIV at time t, IAM(t) - Those co infected with malaria and AIDS at time t, IMT(t) - Those co infected

with malaria and TB at time t, IHT(t) - Those co infected with HIV and TB at time t, IAT(t) - Those co infected

with AIDS and TB at time t, IHMT(t) - Those co infected with HIV, Malaria and TB at time t, IAMT(t) - Those co

infected with AIDS, Malaria and TB at time t. The total human population (NH(t)) is therefore denoted by:

NH(t) = SH(t) + IM(t) + IH(t) + IA(t) + IT(t) + IHM(t) + IAM(t) + IMT(t) + IHT(t) + IAT(t) + IHMT(t) + IAMT(t).

The vector (mosquito) population at time t denoted by NV(t) is sub-divided into the following classes:

SV(t) - Vector susceptibles at time t, IV(t) Vector infectives at time t. The total vector population NV(t) is

given by NV(t) = SV(t) + IV(t).

2.1 Definition Of Parameters

It is assumed that susceptible humans are recruited into the population at a constant rate either by birth

or recovery from malaria and TB. They acquire infection with either HIV/AIDS, malaria or TB and move to the

infectious classes. Susceptible mosquitoes are recruited into the mosquito population at a constant rate. They

acquire malaria infection following a blood meal feeding on infected malaria humans, becomes infectious and

move to the infectious class .

DOI: 10.9790/5728-11643343

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The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

The recruitment rate of humans into the susceptible population is denoted by H while that of vectors

(mosquitoes) is denoted by V and are both assumed to be constant. The natural death rate of humans is given

by dn while that of vectors is given by dv. The death rates due to AIDS, malaria and TB in humans are da, dm and

dt respectively. The parameters dam, dmt, dat and damt account for the combined death rates in the IAM, IMT, IAT and

IAMT classes respectively. The parameters rm and rt are the recovery rates from malaria and TB respectively due

to effective treatment. It is assumed that the recovered individuals do not acquire temporary immunity to either

or both diseases thus become susceptible again. The model assumes that susceptible humans cannot

simultaneously get infected with malaria, HIV/AIDS and TB since the transmission mechanics are completely

different for the three diseases. The model further assumes that humans acquire HIV/AIDS through sexual

contacts between an infective and a susceptible. The average force of infection for HIV/AIDS denoted ah is

given by

where a is the average transmission probability of HIV/AIDS between an infective and a susceptible per sexual

contact and c1 is the per capita number of sexual contacts of susceptible humans with HIV/AIDS infected

individuals per unit time. The parameter measures the effectiveness of counseling through condom use and a

reduction in the number of sexual partners, where 0 1. Effective counseling reduces the value of the

parameter c 1. The model assumes that the classes IHMT, IA, IAM, IAT and IAMT do not transmit the virus due to

acute

ill

health

and

noticeable

AIDS

symptoms.

Define 1 as the number of bites per human per mosquito (biting rate of mosquitoes), m as the transmission

probability of malaria in humans per bite thus the force of infection with malaria for humans, denoted mh is

given by

whereas the average force of infection with malaria for vectors, denoted mv is given by

where v is the transmission probability of malaria in vectors from any infected human. Finally the average force

of infection for TB denoted th is given by

where t is the transmission probability of TB in humans and c2 is the average per capita contact rate of

susceptible humans with TB infected individuals. The rate of progression from HIV to AIDS for the untreated

HIV cases is p. The parameters 1p, 2p and 3p account for increased rates of progression to AIDS for

individuals co infected with HIV - TB, HIV - malaria and HIV malaria - TB respectively where 1 < 2 < 3.

Define as the proportion of the HIV/AIDS infectives receiving effective treatment. This involves the

administration of ARVS that keeps the HIV patients from progressing to AIDS while transferring the AIDS

patients back to the HIV classes. The modification parameters ehm, eht and ehmt account for the reduced

susceptibility to infection with HIV for individuals in the IM, IT and the IMT classes respectively due to reduced

sexual activity as a result of ill health where

h

emh 1 , eth 1 , ehm < 1, emt

1 . The parameters eam , ehm ,

ehtm , eatm , account for the increased susceptibility to infection with malaria for individuals already infected with

AIDS, HIV, HIV - TB and AIDS - TB respectively due to suppressed immune system where ema > 1, emh > 1,

emht > 1, emat > 1. It is also clear that ema < emat and em h < emht. The parameters eth, eta, etmh and etam

account for the increased susceptibility to infection with TB for individuals already infected with HIV, AIDS,

HIV - malaria and AIDS - malaria respectively due to suppressed immune system where eth > 1, eta > 1,

ethm > 1, etam > 1. Again eth < ethm and et a < etam. Malaria and TB does not lead to the depletion of the CD4+

cell counts, however their association with HIV/AIDS leads to a significant reduction in the CD4+ cell counts

within an individual leading to faster progression to AIDS. Combining all the aforementioned assumptions and

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The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

definitions, the model for the transmission dynamics of HIV/AIDS, TB and malaria is given by the following

system of differential equations.

2.2 The Model Equations

The model system 2.2.1 describes living populations therefore the associated state variables are nonnegative for all time t > 0. The solutions of this model with positive initial data therefore remain positive for all

DOI: 10.9790/5728-11643343

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35 | Page

The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

time

>

0.

then

then

We can proceed in a similar manner and show that all the state variables are positive for all time t.

be any solution with non-negative initial conditions. The rate of change of the total human population

with

time

is

given

DOI: 10.9790/5728-11643343

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by:

36 | Page

The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

III.

In the absence of infection by all the diseases, the model 2.2.1, has a steady state solution called

the disease-free equilibrium (DFE) given by

Define Fi as the rate of appearance of new infections in the class or compartment i and Vi = Vi Vi+, where

Vi is the rate of transfer of individuals out of compartment i, and Vi+ is the rate of transfer of individuals into

compartment i by all other means. The Jacobian of Fi and Vi at the disease-free equilibrium is given by:

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The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

DOI: 10.9790/5728-11643343

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The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

3.1 Parameter Values For The Hiv/Aids Malaria Model

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The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

Table 1

Lemma 2.3. The DFE of HIV/AIDS, TB and malaria model is locally asymptotically stable (LAS)

if RHMT < 1, and unstable otherwise.

Lemma 2.3 is illustrated numerically in figure 1 using RH = 0.51, RT = 0.69 and RM = 0.50.

Figure 1

Biologically, lemma 2.3 implies that the infections can be eliminated from the community when RHMT

< 1. This is only true if the initial sizes of the subpopulations of the model are in the basin of attraction of

E0htm. To ensure that elimination of the virus is independent of the initial sizes of the subpopulations, it is

necessary to show that the DFE is globally asymptotically stable.

3.2 Global Stability Of Disease-Free Equilibrium (Dfe)

The global asymptotic stability (GAS) of the disease-free state of the model is investigated using the

theorem by Castillo-Chavez et al. (2002). The model is re written as follows:

where the components of the column-vector X Rm denote the uninfected population and the components

of Z Rn denote the infected population. E0 = (X, 0), denotes the disease-free equilibrium of this system.

The fixed point E0 = (X, 0) is a globally asymptotically stable equilibrium for this system provided that R0

< 1 (locally asymptotically stable) and the following two conditions satisfied:

where P = DZG(X, 0) is an M-matrix (the off diagonal elements of P are non negative) and H is the

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The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

region where the model makes biological sense. The disease free equilibrium is now denoted as E0 = (X, 0),

Theorem 2.4. The fixed point E0 = (X, 0) is a globally asymptotically stable equilibrium of system

2.2.1 provided that

RHMT

< 1 and the assumptions

H1 and H2 are satisfied.

This implies that there is the possibility of future disease outbreaks when the conditions favouring the

outbreaks are prevailing due to the phenomenon of backward bifurcation.

3.3

A bifurcation point is a point in parameter space where the number of equilibrium points, or their

stability properties, or both, change. As noted earlier, an infectious disease does not invade a population of the

susceptible population when the basic reproduction number is less than unity. The epidemiological implication

of backward bifurcation is that reducing the basic reproduction number to less than unity is not sufficient to

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41 | Page

The local and global stability of the disease free equilibrium in a co infection model of HIV/AIDS,

control an epidemic. When the basic reproduction number is unity each infectious individual causes one new

infection therefore, whether a disease invades with the basic reproduction number equal to unity will be

determined by whether the basic reproduction number increases or decreases as the disease increases along the

centre manifold. When backward bifurcation occurs, the diseases-free equilibrium may not be globally

asymptotically stable even if the basic reproduction number is less than unity and thus a stable endemic state coexists with the diseases-free equilibrium. This is numerically illustrated in figure 2 which shows the total

infected population against time in days using the following parameter values: a = 0.0129, c1 = 25.6, d = 0.9, dt

= 0.2, rt = 0.03, m = 0.05, 1 = 0.158, dm = 0.007, dmt = 0.07667, dv = 0.021, rm = 0.99. The other parameter

values are as in table 1.

Figure 2

IV.

Conclusion

In summery The local stability of the disease free equilibrium was investigated by Theorem two by

Van, P. and Watmough, J. [26]. The theorem showed that the HIV/AIDS, TB and malaria co infection model

have a disease free equilibrium point which is locally asymptotically stable whenever the reproduction number

is less than unity. To ensure that elimination of the virus is independent of the initial sizes of the

sub-populations, the global asymptotic stability (GAS) of the disease free state of the model was investigated

using the theorem by Castillo-Chavez et al. [8] and showed that the model posses an unstable global disease free

equilibrium which implies that there is the possibility of future disease outbreaks when the conditions favouring

the outbreaks are prevailing, even though their reproduction numbers is less than unity which results into the

backward bifurcation phenomenon. The theorem by Castillo-Chavez and Song (2004) was employed to

investigate the possible occurrence of backward bifurcation. The epidemiological implication of backward

bifurcation is that reducing the basic reproduction number to less than unity is not sufficient to control an

epidemic. When backward bifurcation occurs, then a stable endemic state co-exists with the diseases-free

equilibrium which posses a challenge to the design of effective control measures to be adopted.

Acknowledgements

The author is very grateful to Prof. Adiel M. Magana of Chuka University - Kenya, for many excellent

comments that have enhanced the model as well as the clarity of the paper

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