scholarly journals Projected Impact of Concurrently Available Long-Acting Injectable and Daily-Oral HIV Pre-Exposure Prophylaxis: A Mathematical Model

2019 ◽  
Author(s):  
Kevin M. Maloney ◽  
Adrien Le Guillou ◽  
Robert A. Driggers ◽  
Supriya Sarkar ◽  
Emeli J. Anderson ◽  
...  
Keyword(s):  
Reference Model ◽  
Dynamic Network ◽  
Population Level ◽  
Reference Scenario ◽  
Initiation Rate ◽  
Substantial Impact ◽  
Population Impact ◽  
Southeastern Us ◽  
Long Acting ◽  
Exposure Prophylaxis

ABSTRACTBackgroundLong-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) is reportedly efficacious, although full trial results have not been published. We used a dynamic network model of HIV transmission among men who have sex with men (MSM) to assess the population impact of LAI-PrEP when available concurrently with daily-oral (DO) PrEP.MethodsWe calibrated our reference model to the current HIV epidemiology and DO-PrEP coverage (15% among indicated) among MSM in the southeastern US. Primary analyses investigated varied PrEP uptake and proportion selecting LAI-PrEP. Secondary analyses evaluated uncertainty in pharmacokinetic efficacy and LAI-PrEP persistence relative to DO-PrEP.ResultsCompared to the reference scenario, if 50% chose LAI-PrEP, 4.3% (95% SI: -7.3%, 14.5%) of infections would be averted over 10 years. LAI-PrEP impact is slightly greater than the DO-PrEP only regimen from higher adherence and partial protection after discontinuation. If the total PrEP initiation rate doubled, 17.1% (95% SI: 6.7%, 26.4%) of infections would be averted. The highest population-level impact occurred when LAI-PrEP uptake and persistence improved.ConclusionsIf LAI-PrEP replaces DO-PrEP, its availability will modestly improve the population impact. LAI-PrEP will make a more substantial impact if its availability drives higher total PrEP coverage, or if persistence if greater among LAI-PrEP users.

scholarly journals Projected Impact of Concurrently Available Long-Acting Injectable and Daily-Oral Human Immunodeficiency Virus Preexposure Prophylaxis: A Mathematical Model

2020 ◽  
Vol 223 (1) ◽  
pp. 72-82
Author(s):  
Kevin M Maloney ◽  
Adrien Le Guillou ◽  
Robert A Driggers ◽  
Supriya Sarkar ◽  
Emeli J Anderson ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Reference Model ◽  
Reference Scenario ◽  
Substantial Impact ◽  
Population Impact ◽  
Preexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Long Acting ◽  
The Impact

Abstract Background Long-acting injectable (LAI) human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) is reportedly efficacious, although full trial results have not been published. We used a dynamic network model of HIV transmission among men who have sex with men to assess the population impact of LAI-PrEP when available concurrently with daily-oral (DO) PrEP. Methods The reference model represents the current HIV epidemiology and DO-PrEP coverage (15% among those with behavioral indications for PrEP) among men who have sex with men in the southeastern United States. Primary analyses investigated varied PrEP uptake and proportion selecting LAI-PrEP. Secondary analyses evaluated uncertainty in pharmacokinetic efficacy and LAI-PrEP persistence relative to DO-PrEP. Results Compared with the reference scenario, if 50% chose LAI-PrEP, 4.3% (95% simulation interval, −7.3% to 14.5%) of infections would be averted over 10 years. The impact of LAI-PrEP is slightly greater than that of the DO-PrEP–only regimen, based on assumptions of higher adherence and partial protection after discontinuation. If the total PrEP initiation rate doubled, 17.1% (95% simulation interval, 6.7%–26.4%) of infections would be averted. The highest population-level impact occurred when LAI-PrEP uptake and persistence improved. Conclusions If LAI-PrEP replaces DO-PrEP, its availability will modestly improve the population impact. LAI-PrEP will make a more substantial impact if its availability drives higher total PrEP coverage, or if persistence is greater for LAI-PrEP.

scholarly journals The Potential Impact of Long-Acting Cabotegravir for HIV Prevention in South Africa: A Mathematical Modeling Study

2020 ◽  
Author(s):  
Jennifer A Smith ◽  
Geoffrey P Garnett ◽  
Timothy B Hallett
Keyword(s):  
South Africa ◽  
Hiv Risk ◽  
Adult Population ◽  
Phase Iii ◽  
Substantial Impact ◽  
Hiv Epidemic ◽  
Phase Iii Trials ◽  
Long Acting ◽  
Exposure Prophylaxis ◽  
The Impact

Abstract Background Although effective, some oral pre-exposure prophylaxis (PrEP) users face barriers to adherence using daily pills, which could be reduced by long-acting formulations. Long-acting cabotegravir (CAB LA) is a potential new injectable formulation for human immunodeficiency virus (HIV) PrEP being tested in phase III trials. Methods We use a mathematical model of the HIV epidemic in South Africa to simulate CAB LA uptake by population groups with different levels of HIV risk. We compare the trajectory of the HIV epidemic until 2050 with and without CAB LA to estimate the impact of the intervention. Results Delivering CAB LA to 10% of the adult population could avert more than 15% of new infections from 2023 to 2050. The impact would be lower but more efficient if delivered to populations at higher HIV risk: 127 person-years of CAB LA use would be required to avert one HIV infection within 5 years if used by all adults and 47 person-years if used only by the highest risk women. Conclusions If efficacious, a CAB LA intervention could have a substantial impact on the course of the HIV epidemic in South Africa. Uptake by those at the highest risk of infection, particularly young women, could improve the efficiency of any intervention.

scholarly journals Why is syphilis rising in Europe? Multi-level modelling of alternative hypotheses in 31 countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Mendez-Lopez ◽  
D Stuckler ◽  
T Noori ◽  
J C Semenza
Keyword(s):  
Risky Sexual Behavior ◽  
Population Level ◽  
Internet Survey ◽  
Probability Models ◽  
Syphilis Infection ◽  
Detection Rates ◽  
Substantial Impact ◽  
Multi Level ◽  
Sex With Men ◽  
Linear Probability

Abstract Background Syphilis transmission has increased markedly over the past two decades in Europe, concentrated in men who have sex with men. We test alternative potential social and behavioral individual- and population-level determinants of this resurgence. Methods Two rounds of the cross-sectional European Men who have sex with men Internet Survey (EMIS 2010 and 2017, n = 272,902) were used to fit multi-level linear probability models to evaluate determinants of the incidence of self-reported syphilis, capturing risky sexual behaviours and pre-exposure prophylaxis use, among others, adjusting for potential sociodemographic confounders. Results Self-reported syphilis incidence rates rose by about 1.8 percentage points (within the last 12 months) and 3.9 (within the last 5 years) between the 2010 and 2017 waves, after adjusting for sociodemographic factors. HIV status was a major risk factor for syphilis infection (27.6 ppt higher incident rate, 95%CI: 24.7 to 30.5). A dose-response relationship was observed between greater numbers of condomless non-steady partners and syphilis infection, with more than 10 partners estimating increases in the probability of diagnosis of over 25 ppt (11-20 partners vs none: 24.5 ppt, 95%CI: 20.5 to 28.5); further, we observed evidence of mediation for number of condomless non-steady partners, which attenuated the estimated rise in 2017 vs 2010 by about 35%. STI testing uptake also accounted for a substantial increase in syphilis incidence signaling higher detection rates over time. While country-level PrEP use was linked to greater number of condomless partners, there was no substantial impact of population-wide factors, including GDP and PrEP use, on overall syphilis trends. Conclusions Risky sexual behavior changes, particularly condomless sex with non-steady partners, appears to be a major contributing factor to rising syphilis incidence. Further research is needed to understand what accounts for this substantial behavior change. Key messages Increased number of condomless non-steady partners accounts for a substantial rise in syphilis trends. Population-level PrEP use was linked to increasing numbers of condomless non-steady partners but had no substantial impact on overall syphilis trends.

scholarly journals Qualitative Consumer Research on Acceptance of Long-Acting Pre-Exposure Prophylaxis Products Among Men Having Sex with Men and Medical Practitioners in the United States

2018 ◽  
Vol 34 (10) ◽  
pp. 849-856 ◽  
Author(s):  
Bobby J. Calder ◽  
Robert J. Schieffer ◽  
Ewa Bryndza Tfaily ◽  
Richard D'Aquila ◽  
George J. Greene ◽  
...  
Keyword(s):  
United States ◽  
Consumer Research ◽  
The United States ◽  
Medical Practitioners ◽  
Sex With Men ◽  
Long Acting ◽  
Exposure Prophylaxis

scholarly journals Prediction of disability-adjusted life years for diseases due to low fruit intake in 2017–2040 in Japan

2020 ◽  
pp. 1-11
Author(s):  
Daisuke Yoneoka ◽  
Shuhei Nomura ◽  
Shiori Tanaka ◽  
Aya Ishizuka ◽  
Ueda Peter ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Moving Average ◽  
Current Trend ◽  
Population Level ◽  
Fruit Intake ◽  
Reference Scenario ◽  
Future Scenarios ◽  
Disability Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years

Abstract Objective: The current study aimed to predict disability-adjusted life years (DALY) rate in Japan through 2040 with plausible future scenarios of fruit intake for neoplasms, cardiovascular diseases (CVD) and diabetes and kidney diseases (DKD). Design: Data from National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017 were used. We developed an autoregressive integrated moving average model with four future scenarios. Reference scenario maintains the current trend. Best scenario assumes that the goal defined in Health Japan 21 is achieved in 2023 and is kept constant afterwards. Moderate scenario assumes that the goal is achieved in 2040. Constant scenario applies the same proportion of 2016 for the period between 2017 and 2040. Setting: DALY rates in Japan were predicted for the period between 2017 and 2040. Participants: Population aged more than than 20 years old. Results: In our reference forecast, the DALY rates in all-ages group were projected to be stable for CVD and continue increasing for neoplasms and DKD. Age group-specific DALY rates for these three disease groups were forecasted to decrease, with some exceptions. Among men aged 20–49 years, DALY attributable to CVD differed substantially between the scenarios, implying that there is a significant potential for reducing the burden of CVD by increasing fruit intake at the population level. Conclusions: Our scenario analysis shows that higher fruit intake is associated with lower disease burden in Japan. Further research is required to assess which policies and interventions can be used to achieve an increase in fruit intake as modelled in the scenarios of the current study.

scholarly journals Awareness about and willingness to use long-acting injectable pre-exposure prophylaxis (LAI-PrEP) among people who use drugs

2020 ◽  
Vol 117 ◽  
pp. 108058 ◽  
Author(s):  
Roman Shrestha ◽  
Elizabeth E. DiDomizio ◽  
Rayne S. Kim ◽  
Frederick L. Altice ◽  
Jeffrey A. Wickersham ◽  
...  
Keyword(s):  
People Who Use Drugs ◽  
Long Acting ◽  
Willingness To Use ◽  
Exposure Prophylaxis

scholarly journals Modelling the household-level impact of a maternal respiratory syncytial virus (RSV) vaccine in a high-income setting

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Patricia T. Campbell ◽  
Nicholas Geard ◽  
Alexandra B. Hogan
Keyword(s):  
Respiratory Syncytial Virus ◽  
Vaccine Trial ◽  
Population Level ◽  
High Income ◽  
Demographic Model ◽  
Model Framework ◽  
Substantial Impact ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
The Impact

Abstract Background Respiratory syncytial virus (RSV) infects almost all children by the age of 2 years, with the risk of hospitalisation highest in the first 6 months of life. Development and licensure of a vaccine to prevent severe RSV illness in infants is a public health priority. A recent phase 3 clinical trial estimated the efficacy of maternal vaccination at 39% over the first 90 days of life. Households play a key role in RSV transmission; however, few estimates of population-level RSV vaccine impact account for household structure. Methods We simulated RSV transmission within a stochastic, individual-based model framework, using an existing demographic model, structured by age and household and parameterised with Australian data, as an exemplar of a high-income country. We modelled vaccination by immunising pregnant women and explicitly linked the immune status of each mother-infant pair. We quantified the impact on children for a range of vaccine properties and uptake levels. Results We found that a maternal immunisation strategy would have the most substantial impact in infants younger than 3 months, reducing RSV infection incidence in this age group by 16.6% at 70% vaccination coverage. In children aged 3–6 months, RSV infection was reduced by 5.3%. Over the first 6 months of life, the incidence rate for infants born to unvaccinated mothers was 1.26 times that of infants born to vaccinated mothers. The impact in older age groups was more modest, with evidence of infections being delayed to the second year of life. Conclusions Our findings show that while individual benefit from maternal RSV vaccination could be substantial, population-level reductions may be more modest. Vaccination impact was sensitive to the extent that vaccination prevented infection, highlighting the need for more vaccine trial data.

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