Short- and Long-Term Pharmacologic Measures of HIV Pre-exposure Prophylaxis Use Among High-Risk Men Who Have Sex With Men in HPTN 067/ADAPT

ObjectivesSince 2017, the Public Health Agency of Sweden recommends that pre-exposure prophylaxis (PrEP) for HIV should be offered to high-risk individuals, in particular to men who have sex with men (MSM). The objective of this study is to develop a mathematical model investigating the effect of introducing PrEP to MSM in Sweden.DesignA pair formation model, including steady and casual sex partners, is developed to study the impact of introducing PrEP. Two groups are included in the model: sexually high active MSM and sexually low active MSM. Three mixing assumptions between the groups are considered.SettingA gay-friendly MSM HIV/sexually transmitted infection testing clinic in Stockholm, Sweden. This clinic started offering PrEP to MSM in October 2018.ParticipantsThe model is calibrated according to detailed sexual behaviour data gathered in 2015 among 403 MSM.ResultsBy targeting sexually high active MSM, a PrEP coverage of 3.5% of the MSM population (10% of all high actives) would result in the long-term HIV prevalence to drop considerably (close to 0%). While targeting only low actives would require a PrEP coverage of 35% for a similar reduction. The main effect of PrEP is the reduced susceptibility, whereas the increased HIV testing rate (every third month) among PrEP users plays a lesser role.ConclusionsTo create a multifaceted picture of the effects of interventions against HIV, we need models that include the different stages of HIV infection and real-world data on detailed sexual behaviour to calibrate the mathematical models. Our findings conclude that targeting HIV high-risk individuals, within HIV risk populations such as MSM, with PrEP programmes could greatly decrease the long-term HIV prevalence in Sweden. Therefore, risk stratification of individuals is of importance in PrEP implementation programmes, to ensure optimising the effect and cost-effectiveness of such programmes.

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Cost-Effectiveness Analysis of the Daily HIV Pre-Exposure Prophylaxis in Men who Have Sex with Men in Barcelona

10.20944/preprints202111.0295.v1 ◽

2021 ◽

Author(s):

Francesc López Seguí ◽

Unai Oyon Lerga ◽

Laura Laguna Marmol ◽

Pep Coll ◽

Angels Andreu ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Time Horizon ◽

Cost Savings ◽

Health Indicators ◽

Hiv Infections ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Oral Prep

Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia, a territory with extensive implementation. Methods: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price). A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. Results: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. Conclusions: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.

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Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)?

Eurosurveillance ◽

10.2807/1560-7917.es.2017.22.25.30553 ◽

2017 ◽

Vol 22 (25) ◽

Cited By ~ 53

Author(s):

Alison E Brown ◽

Hamish Mohammed ◽

Dana Ogaz ◽

Peter D Kirwan ◽

Mandy Yung ◽

...

Keyword(s):

High Risk ◽

Sexual Health ◽

Hiv Testing ◽

Health Clinics ◽

High Risk Populations ◽

Sex With Men ◽

Sexual Health Clinics ◽

Exposure Prophylaxis

Since October 2015 up to September 2016, HIV diagnoses fell by 32% compared with October 2014–September 2015 among men who have sex with men (MSM) attending selected London sexual health clinics. This coincided with high HIV testing volumes and rapid initiation of treatment on diagnosis. The fall was most apparent in new HIV testers. Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable.

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Impact of HIV risk perception on both pre-exposure prophylaxis and condom use

Journal of Health Psychology ◽

10.1177/1359105319883927 ◽

2019 ◽

pp. 135910531988392

Author(s):

Marion Di Ciaccio ◽

Luis Sagaon-Teyssier ◽

Christel Protière ◽

Mohamed Mimi ◽

Marie Suzan-Monti ◽

...

Keyword(s):

Risk Perception ◽

High Risk ◽

Condom Use ◽

Hiv Risk ◽

Health Behaviours ◽

Two Dimensions ◽

Hiv Risk Perception ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Trajectory Modelling

Risk perception is one of the several important factors impacting sexual health behaviours. This study investigated the evolution of HIV risk perception on pre-exposure prophylaxis adherence and condom use in men who have sex with men at high risk of HIV and associated factors. Group-based trajectory modelling helped in identifying patterns of risk perception, pre-exposure prophylaxis adherence and condom use over time. The association between the former and the latter two dimensions was then investigated. An estimated 61 per cent ( p < 0.001) of participants perceiving low risk and 100 per cent ( p < 0.001) of those perceiving high risk had systematic pre-exposure prophylaxis adherence, while an estimated 49 per cent ( p < 0.001) and 99.8 per cent ( p < 0.001), respectively, reported low-level condom use.

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Community-Based Care in the ANRS-IPERGAY Trial: The Challenges of Combination Prevention

AIDS Education and Prevention ◽

10.1521/aeap.2019.31.3.259 ◽

2019 ◽

Vol 31 (3) ◽

pp. 259-272 ◽

Cited By ~ 1

Author(s):

Costanza Puppo ◽

Xavier Mabire ◽

Laurent Cotte ◽

Daniela Rojas Castro ◽

Bruno Spire ◽

...

Keyword(s):

High Risk ◽

Health Workers ◽

Open Label ◽

Community Based ◽

Double Blind ◽

Combination Prevention ◽

Open Label Extension ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The Relationship

ANRS-IPERGAY was a community-based randomized trial investigating the efficacy of sexual activity-based HIV pre-exposure prophylaxis (PrEP) in a population of males and transgender females who had sex with men and were at high risk of HIV infection. We qualitatively analyzed the support provided to participants by community-based health workers (CBHW) throughout the trial's double-blind and open-label extension phases. In particular, we showed that the relationship between participants and CBHW strongly influenced self-managed pill intake. The delicate construction of this relationship, balanced between trust and dependence, played an important role in PrEP adherence. CBHW had to deal with various issues surrounding participants' feelings of empowerment regarding their role in the trial, as well as related tensions between various logics and rationalities. They were essential to participants' continued involvement.

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Tenofovir Urine Assay to Monitor Adherence to HIV Pre-exposure Prophylaxis

Current Clinical Pharmacology ◽

10.2174/1574884714666191111125348 ◽

2020 ◽

Vol 15 (2) ◽

pp. 102-104

Author(s):

Ganesh S. Moorthy ◽

Linden Lalley-Chareczko ◽

Helen C. Koenig ◽

Athena F. Zuppa

Keyword(s):

High Performance ◽

Retention In Care ◽

Self Report ◽

Resource Limited ◽

Hepatitis B Treatment ◽

Urine Assay ◽

Tenofovir Alafenamide ◽

Sex With Men ◽

Exposure Prophylaxis

Tenofovir Disoproxil Fumarate (TDF) and tenofovir Alafenamide (TAF) are prodrugs of tenofovir and have excellent long-term efficacy and tolerability for the treatment of HIV. An objective marker of adherence to tenofovir-based therapy could be clinically useful in supporting adherence to TDF-based HIV pre-Exposure Prophylaxis (PrEP) in populations in whom, self-report has been shown to be unreliable, and could play a role in resource-limited settings to support HIV and hepatitis B treatment adherence. A semi-quantitative high-performance liquid chromatographymass spectrometry method for tenofovir quantification of urine samples was developed. This assay detects tenofovir concentration in log10 levels between 1 and 10,000 ng/mL, and was shown to distinguish between recent adherence and low/non-adherence to both TDF and TAF, with a concentration of >1000 ng/mL, highly predictive of medication ingestion in the last 24-48 hours. This assay was validated relative to other markers of adherence including dried blood spot and selfreport in a highly adherent population of PrEP patients, and tenofovir was shown to be stable at room temperature in urine for at least 14 days. The assay was successfully used in a clinical setting to maintain high PrEP adherence and retention in care of 50 young men who have sex with men (MSM) over 48 weeks, to assess PrEP adherence in youth with mental health conditions, and to monitor drug levels relative to plasma levels in a case study of chewed TDF/FTC (tenofovir/emtricitabine) for PrEP. Further studies are underway to implement the tenofovir urine assay to monitor adherence and pre-exposure prophylaxis, nationally and internationally.

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Condom use in China: prevalence, policies, issues and barriers

Sexual Health ◽

10.1071/sh11021 ◽

2012 ◽

Vol 9 (1) ◽

pp. 27 ◽

Cited By ~ 19

Author(s):

Huachun Zou ◽

Hui Xue ◽

Xiaofang Wang ◽

Damien Lu

Keyword(s):

High Risk ◽

Condom Use ◽

Migrant Workers ◽

Sex Workers ◽

High Rate ◽

Sexually Transmissible Infections ◽

Discordant Couples ◽

Promotion Strategies ◽

Sex With Men

In this review, we describe condom use and its influencing factors in China, with a particular focus on the five populations that are at high risk for HIV/sexually transmissible infections (STI) infection: female sex workers, men who have sex with men, migrant workers, young people and sero-discordant couples. The risk for HIV/STI infection is high while condom use rates are low among these five populations. The 100% Condom Use Programme was successful in trial regions in increasing condom use and decreasing HIV/STI prevalence; however, long-term and routine condom promotion strategies should be in place to ensure better awareness of condom use, high availability of condoms and high rate of condom use among populations at high risk of HIV/STI infection in China. Realistic and vigorous condom-related policies and action plans should be developed and implemented to address the issues and barriers facing condom promotion in China.

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Short- and long-term prognostic role of diastolic blood pressure in intermediate-high risk patients with acute pulmonary embolism

European Journal of Internal Medicine ◽

10.1016/j.ejim.2018.07.016 ◽

2018 ◽

Vol 55 ◽

pp. e23-e24

Author(s):

Marco Zuin ◽

Gianluca Rigatelli ◽

Pietro Zonzin ◽

Franco Casazza ◽

Loris Roncon

Keyword(s):

Blood Pressure ◽

Pulmonary Embolism ◽

High Risk ◽

Diastolic Blood Pressure ◽

Acute Pulmonary Embolism ◽

Prognostic Role ◽

Risk Patients ◽

Short And Long Term

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Troponin T in patients with low grade or atypical angina. Identification of a high risk group for short- and long-term cardiovascular events

European Heart Journal ◽

10.1053/euhj.1998.1233 ◽

1998 ◽

Vol 19 (12) ◽

pp. 1802-1807 ◽

Cited By ~ 20

Author(s):

M. Möckel ◽

T. Störk ◽

G. Heller ◽

L. Röcker ◽

O. Danne ◽

...

Keyword(s):

High Risk ◽

Cardiovascular Events ◽

Risk Group ◽

Troponin T ◽

High Risk Group ◽

Low Grade ◽

Short And Long Term

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A Web-Based Study of HIV Prevention in the Era of Pre-Exposure Prophylaxis Among Vulnerable HIV-Negative Gay and Bisexual Men, Transmen, and Transwomen Who Have Sex With Men: Protocol for an Observational Cohort Study (Preprint)

10.2196/preprints.13715 ◽

2019 ◽

Author(s):

Denis Nash ◽

Matthew Stief ◽

Caitlin MacCrate ◽

Chloe Mirzayi ◽

Viraj V Patel ◽

...

Keyword(s):

High Risk ◽

Hiv Prevention ◽

Hiv Testing ◽

The United States ◽

Racially Diverse ◽

Web Based ◽

Sex With Men ◽

Hiv Acquisition ◽

Exposure Prophylaxis ◽

Hiv Negative

BACKGROUND Gay, bisexual, and other men who have sex with men continue to bear a large burden of the HIV epidemic in the United States and are among the only populations with increasing incidence in recent years. OBJECTIVE The Together 5000 (T5K) Study aimed to enroll a US-based, racially diverse sample of HIV-negative men, transmen, and transwomen who are not on pre-exposure prophylaxis (PrEP) into an observational cohort to inform the design, implementation, scale-up, and evaluation of HIV prevention programs. METHODS We used internet-based strategies to enroll a large, racially diverse national sample of HIV-negative men, transmen, and transwomen aged 16 to 49 years at high risk of HIV acquisition via sexual networking apps. Study participants are contacted every 6 months (in between annual surveys) for a brief survey on HIV testing, HIV diagnosis, and PrEP use (ie, attempts to access, PrEP initiation, and PrEP discontinuation). Participants complete annual self-administered at-home HIV testing and Web-based surveys. Using baseline serologic data and self-reported HIV testing history, we reconstructed a cohort of persons who were HIV negative at 12 months before baseline to estimate HIV incidence leading up to cohort enrollment. RESULTS The study sample included 8777 participants from all 50 US states, Puerto Rico, and Guam; 50.91% (4468/8777) were persons of color and 25.30% (2221/8777) were young individuals aged 16 to 24 years. Per eligibility criteria, all T5K participants reported having sex with >2 male partners in the 90 days before enrollment, self-reported not having been diagnosed with HIV, and were not actively taking PrEP. In addition, 79.39% (6968/8777) reported >2 insertive condomless anal sex (CAS) acts, 61.02% (5356/8777) reported >1 receptive CAS acts in the past 90 days. Furthermore, most (7525/8777, 85.74%) reported never having taken PrEP. In total, 70.25% (6166/8777) were sent a self-administered at-home HIV test kit and 82.29% (5074/6166) of those sent a kit returned a sample for testing. The HIV incidence rate during the 12-month period leading up to enrollment was estimated to be 2.41 (95% CI 2.02-2.90) per 100 person-years. CONCLUSIONS A large, national, and racially diverse fully Web-based cohort of HIV-negative men, transmen, and transwomen at high risk for HIV seroconversion has successfully been recruited into longitudinal follow-up. This cohort is at high risk for HIV acquisition and can provide important insights related to the real-world uptake, impact, and equity of HIV prevention interventions in the United States. Participants can be invited to participate in trials aimed at testing strategies to improve the uptake of and engagement in these interventions. INTERNATIONAL REGISTERED REPORT RR1-10.2196/13715

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