Evaluating the impact of policies recommending PrEP to subpopulations of men and transgender women who have sex with men based on demographic and behavioral risk factors

English version

Autoři: Holly Janes ^aff001; Marshall D. Brown ^aff001; David V. Glidden ^aff002; Kenneth H. Mayer ^aff003; Susan P. Buchbinder ^aff004; Vanessa M. McMahan ^aff005; Mauro Schechter ^aff006; Juan Guanira ^aff007; Martin Casapia ^aff008
Působiště autorů: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America ^aff001; Department of Epidemiology and Biostatistics, University of California School of Medicine, San Francisco, California, United States of America ^aff002; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America ^aff003; Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America ^aff004; Department of Medicine, University of Washington, Seattle, Washington, United States of America ^aff005; Projeto Praça Onze, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil ^aff006; Asociación Civil Impacta Salud y Educación, Lima, Peru ^aff007; Asociación Civil Selva Amazónica, Iquitos, Peru ^aff008
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222183

Souhrn

Introduction

Developing guidelines to inform the use of antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention in resource-limited settings must necessarily be informed by considering the resources and infrastructure needed for PrEP delivery. We describe an approach that identifies subpopulations of cisgender men who have sex with men (MSM) and transgender women (TGW) to prioritize for the rollout of PrEP in resource-limited settings.

Methods

We use data from the iPrEx study, a multi-national phase III study of PrEP for HIV prevention in MSM/TGW, to build statistical models that identify subpopulations at high risk of HIV acquisition without PrEP, and with high expected PrEP benefit. We then evaluate empirically the population impact of policies recommending PrEP to these subpopulations, and contrast these with existing policies.

Results

A policy recommending PrEP to a high risk subpopulation of MSM/TGW reporting condomless receptive anal intercourse over the last 3 months (estimated 3.3% 1-year HIV incidence) yields an estimated 1.95% absolute reduction in 1-year HIV incidence at the population level, and 3.83% reduction over 2 years. Importantly, such a policy requires rolling PrEP out to just 59.7% of MSM/TGW in the iPrEx population. We find that this policy is identical to that which prioritizes MSM/TGW with high expected PrEP benefit. It is estimated to achieve nearly the same reduction in HIV incidence as the PrEP guideline put forth by the US Centers for Disease Control, which relies on the measurement of more behavioral risk factors and which would recommend PrEP to a larger subset of the MSM/TGW population (86% vs. 60%).

Conclusions

These findings may be used to focus future mathematical modelling studies of PrEP in resource-limited settings on prioritizing PrEP for high-risk subpopulations of MSM/TGW. The statistical approach we took could be employed to develop PrEP policies for other at-risk populations and resource-limited settings.

Klíčová slova:

Biology and life sciences – Organisms – People and places – Population groupings – Medicine and health sciences – Microbiology – Medical microbiology – Microbial pathogens – Pathology and laboratory medicine – Pathogens – Infectious diseases – Viral pathogens – Immunodeficiency viruses – HIV – Retroviruses – Lentivirus – Viruses – RNA viruses – Public and occupational health – Preventive medicine – Viral diseases – HIV infections – Sexually transmitted diseases – Epidemiology – Medical risk factors – Sexuality groupings – Men who have sex with men – HIV epidemiology – Prophylaxis – Pre-exposure prophylaxis – HIV prevention

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