# Reassessment of public awareness and prevention strategies for HIV and COVID-19 co-infections through epidemic modeling

## TL;DR

This paper uses epidemic modeling to study how public awareness and interventions affect the spread of HIV and COVID-19 when they co-occur in a population.

## Contribution

The paper introduces a co-infection model with optimal control strategies for HIV and COVID-19, revealing bistability and backward bifurcation phenomena.

## Key findings

- The co-infection model's reproduction number is the maximum of HIV and COVID-19 reproduction numbers.
- Bistability between disease-free and endemic states can occur in the single-infection COVID-19 model even when the reproduction number is less than one.
- Optimal control strategies combining interventions like vaccination and public awareness are critical for reducing co-infection spread.

## Abstract

A co–infection model between HIV and COVID-19 that takes into account COVID-19 vaccination and public awareness is discussed in this article. Rigorous analysis of the model is conducted to establish the existence and local stability conditions of the single-infection models. We discover that when the corresponding reproduction number for COVID-19 and HIV exceeds one, the disease continues to exist in both single-infection models. Furthermore, HIV will always be eradicated if its reproduction number is less than one. Nevertheless, this does not apply to the single-infection COVID-19 model. Even when the fundamental reproduction number is less than one, an endemic equilibrium point may exist due to the potential for a backward bifurcation phenomenon. Consequently, in the single-infection COVID-19 model, bistability between the endemic and disease-free equilibrium may arise when the basic reproduction number is less than one. From the co–infection model, we find that the reproduction number of the co–infection model is the maximum value between the reproduction number of HIV and COVID-19. Our numerical continuation experiments on the co–infection model reveal a threshold indicating that both HIV and COVID-19 may coexist within the population. The disease-free equilibrium for both HIV and COVID-19 is stable only if the reproduction numbers are less than one. Additionally, our two-parameter continuation analysis of the bifurcation diagram shows that the condition where both reproduction numbers equal one serves as an organizing center for the dynamic behavior of the co-infection model. An extended version of our model incorporates four different interventions: face mask usage, vaccination, and public awareness for COVID-19, as well as condom use for HIV, formulated as an optimal control problem. The Pontryagin’s Maximum Principle is employed to characterize the optimal control problem, which is solved using a forward-backward iterative method. Numerical investigations of the optimal control model highlight the critical role of a well-designed combination of interventions to achieve optimal reductions in the spread of both HIV and COVID-19.