Estimating the impact of HIV combination prevention in men who have sex with men, the Bangkok MSM Cohort Study, Thailand

2020 ◽  
Vol 31 (7) ◽  
pp. 637-641
Author(s):  
Sarika Pattanasin ◽  
Betsy L Cadwell ◽  
Dawn K Smith ◽  
Wichuda Sukwicha ◽  
Philip A Mock ◽  
...  
Keyword(s):  
Condom Use ◽  
Hiv Infections ◽  
Substantial Impact ◽  
Combination Prevention ◽  
Hiv Epidemic ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Combined Interventions

In Thailand, pre-exposure prophylaxis (PrEP) is recommended for human immunodeficiency virus (HIV) prevention among at-risk men who have sex with men (MSM). We modeled the impact of PrEP and condom use as independent and combined interventions on the estimated number of HIV infections among a hypothetical population of 10,000 MSM in Bangkok, Thailand. Our model demonstrated a 92% (95% confidence interval 89.7, 94.2) reduction in HIV infections among Thai MSM who took daily PrEP and self-reported using condoms correctly and consistently (100% condom use). Increased use of PrEP and condoms likely would have a substantial impact on the HIV epidemic in Thailand.

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 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 Likely impact of pre-exposure prophylaxis on HIV epidemics among men who have sex with men

Sexual Health ◽  
2017 ◽  
Vol 14 (1) ◽  
pp. 97 ◽  
Author(s):  
Iryna B. Zablotska
Keyword(s):  
Hiv Transmission ◽  
Population Level ◽  
Combination Prevention ◽  
The Us ◽  
Implementation Studies ◽  
Prep Implementation ◽  
Modelling Studies ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact

Rapid developments in the field of HIV pre-exposure prophylaxis (PrEP) with antiretrovirals offer a promise to bring HIV transmission among gay and other men who have sex with men (MSM) to zero by 2030. This review evaluates studies, which modelled the impact of PrEP on HIV diagnoses, and discusses the progress towards PrEP implementation. Studies in English, conducted after 2010 among MSM in countries of the Organization for Economic Cooperation and Development (OECD) were reviewed. Six modelling studies were included, three of which had been conducted outside the US. None of the published models showed that PrEP alone can reduce HIV diagnoses to zero and eliminate HIV transmission by 2030. However, PrEP in combination with other biomedical interventions can reduce HIV diagnoses on the population level by ~95%. Other upcoming biomedical prevention strategies may strengthen combination prevention. Access to PrEP remains limited, even in the OECD countries. Modelling studies can assist governments with decision-making about PrEP implementation and add urgency to the implementation of PrEP. More work is needed on modelling of the impact of PrEP on HIV diagnoses trends outside the US where PrEP implementation is in its early stages.

scholarly journals Grindr Users Take More Risks, but Are More Open to Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis: Could This Dating App Provide a Platform for HIV Prevention Outreach?

2019 ◽  
Vol 71 (7) ◽  
pp. e135-e140 ◽  
Author(s):  
Martin Hoenigl ◽  
Susan J Little ◽  
David Grelotti ◽  
Britt Skaathun ◽  
Gabriel A Wagner ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Risk Behavior ◽  
Hiv Infections ◽  
The United States ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Prevention Behavior ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Technology has changed the way that men who have sex with men (MSM) seek sex. More than 60% of MSM in the United States use the internet and/or smartphone-based geospatial networking apps to find sex partners. We correlated use of the most popular app (Grindr) with sexual risk and prevention behavior among MSM. Methods A nested cohort study was conducted between September 2018 and June 2019 among MSM receiving community-based human immunodeficiency virus (HIV) and sexually transmitted infection (STI) screening in central San Diego. During the testing encounter, participants were surveyed for demographics, substance use, risk behavior (previous 3 months), HIV pre-exposure prophylaxis (PrEP) use, and Grindr usage. Participants who tested negative for HIV and who were not on PrEP were offered immediate PrEP. Results The study included 1256 MSM, 1090 of whom (86.8%) were not taking PrEP. Overall, 580 of 1256 (46%) participants indicated that they used Grindr in the previous 7 days. Grindr users reported significantly higher risk behavior (greater number of male partners and condomless sex) and were more likely to test positive for chlamydia or gonorrhea (8.6% vs 4.7% of nonusers; P = .005). Grindr users were also more likely to be on PrEP (18.7% vs 8.7% of nonusers; P < .001) and had fewer newly diagnosed HIV infections (9 vs 26 among nonusers; P = .014). Grindr users were also nearly twice as likely as nonusers to initiate PrEP (24.6% vs 14%; P < .001). Conclusions Given the higher risk behavior and greater acceptance of PrEP among MSM who used Grindr, Grindr may provide a useful platform to promote HIV and STI testing and increase PrEP uptake.

scholarly journals Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

2020 ◽  
Author(s):  
Ross. D. Booton ◽  
Gengfeng Fu ◽  
Louis MacGregor ◽  
Jianjun Li ◽  
Jason J. Ong ◽  
...  
Keyword(s):  
Condom Use ◽  
Viral Suppression ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
Hiv Care ◽  
Art Initiation ◽  
Sex With Men ◽  
One Year ◽  
And Control ◽  
The Impact

AbstractIntroductionThe COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China.MethodsRegional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of sexual partners (62%) and consistency of condom use (25%). A deterministic mathematical model of HIV transmission and treatment among MSM in China was used to estimate the impact of these disruptions on the number of new HIV infections and HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over 1 and 5 years for a 3-, 4- or 6-month disruption period.ResultsOur China model predicted that new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions for a 3-month period increasing HIV infections by 5-14% over 1 year and deaths by 7-12%. Observed reductions in condom use increased HIV infections by 5-14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility testing and ART initiation, but reduced partner numbers resulted in 11-23% fewer infections and 0.4-1.0% fewer deaths. Longer disruption periods of 4 and 6 months amplified the impact of combined disruption scenarios. When all realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections was always predicted over one year (3-17%), but not over 5 years (1% increase-4% decrease), while deaths mostly increased over one year (1-2%) and 5 years (1.2 increase – 0.3 decrease).ConclusionsThe overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19 related disruption on HIV transmission and control among MSM in China.

scholarly journals Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM)

2021 ◽  
Vol 18 (9) ◽  
pp. 4772
Author(s):  
Gianluca Voglino ◽  
Maria Rosaria Gualano ◽  
Stefano Rousset ◽  
Pietro Forghieri ◽  
Isabella Fraire ◽  
...  
Keyword(s):  
Online Survey ◽  
Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Attitudes And Practices ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Prep Awareness ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Knowledge Attitudes And Practices

Background: Pre-exposure prophylaxis (PrEP) is suitable for high human immunodeficiency virus (HIV)-infection risk people, foremost among whom are males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. No previous study has assessed this issue; Methods: An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour and habits, HIV/acquired immune deficiency syndrome (AIDS) knowledge and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify factors associated with PrEP knowledge; Results: A total of 196 MSM participated in this survey. Overall data showed that 87.2% of participants knew what PrEP is, but only 7.5% have ever used it. The main reason for not using PrEP was the cost of the therapy (26.9%). The principal source of PrEP information was the Internet (68.4%). Being regularly tested for HIV was significantly associated with PrEP knowledge (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06–9.29); Conclusions: Knowledge regarding PrEP was well established, but PrEP use was not equally widespread. It is necessary to improve research on PrEP usage in order to PrEP access to be granted.

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

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.

scholarly journals Pre-exposure prophylaxis' knowledge, attitudes, practices amongst italian men who have sex with men

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
G Voglino ◽  
MR Gualano ◽  
S Rousset ◽  
F Bert ◽  
R Siliquini ◽  
...  
Keyword(s):  
Sexual Behaviour ◽  
Online Survey ◽  
Healthcare Personnel ◽  
Attitudes And Practices ◽  
Barriers To Access ◽  
Immunodeficiency Virus ◽  
High Infection ◽  
Sex With Men ◽  
Prep Awareness ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) is suitable for human immunodeficiency virus (HIV)high-infection-risk people, foremost amongst males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. Methods An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour, knowledge on HIV and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify possible associations with PrEP knowledge. Results A total of 196 MSM completed the survey. Overall data showed very good HIV and safe sexual behaviour knowledge (94.4% of correct answers). Nevertheless, our sample rarely used PrEP because of existing barriers: high therapy price (26.9%)and fear of side effects (23.8%). Only 10.3% of partecipants were informed on HIV and PReP by institutional channels, even less (7.5%) from specialized physicians and general practitioners. The most significant association with PrEP knowledge was having regular HIV-tests (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions PreP's Knowledge was well established, but PrEP use was not widespread. It is necessary to improve communication on PrEP and to lower existing barriers in order to grant access to PrEP access. Key messages Barriers to access PrEP have to be lowered. Healthcare personnel has to be involved in PrEP's benefits communication.

scholarly journals Quantitative methods used to evaluate impact of health promotion interventions to prevent HIV infections: a methodological systematic review protocol

2021 ◽  
Author(s):  
Andrainolo Ravalihasy ◽  
Lidia Kardas-Sloma ◽  
Yazdan Yazdanpanah ◽  
Valéry Ridde
Keyword(s):  
Systematic Review ◽  
Health Promotion ◽  
Impact Evaluation ◽  
Quantitative Methods ◽  
Evaluation Studies ◽  
Complex Interventions ◽  
Hiv Infections ◽  
Combination Prevention ◽  
Health Promotion Interventions ◽  
The Impact

Abstract Background Combination prevention is currently considered the best approach to combat HIV epidemic. It is based upon the combination of structural, behavioral and biomedical interventions. Such interventions are frequently implemented in a health promoting manner due to their aims, the approach that was adopted and their complexity. The impact evaluation of these interventions often relies on methods inherited from the biomedical field. However, these methods have limitations and should be adapted to be relevant for these complex interventions. This systematic review aims to map the evidence-based methods used to quantify the impact of these interventions and analyze how these methods are implemented. Methods Three databases (Web of Science, Scopus, PubMed) will be used to identify impact evaluation studies of health promotion interventions that aimed at reducing the incidence or prevalence of HIV infection. Only studies based on quantitative design assessing intervention impact on HIV prevalence or incidence will be included. Two reviewers will independently screen studies based on titles and abstracts and then on the full text. The information about study characteristics will be extracted to understand the context in which the interventions are implemented. The information specific to quantitative methods of impact evaluation will be extracted using items from the Mixed Methods Appraisal Tool (MMAT), the guidelines for reporting Statistical Analyses and Methods in the Published Literature (SAMPL) and the guidelines for Strengthening The Reporting of Empirical Simulation Studies (STRESS). This review will be conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Discussion The impact evaluation of HIV prevention interventions is a matter of substantial importance given the growing need for evidence of the effectiveness of these interventions whereas they are increasingly complex. These evaluations allow to identify the most effective strategies to be implemented to fight the epidemic. It is therefore relevant to map the methods to better implement them and adapt them according to the type of intervention to be evaluated. Systematic review registration: PROSPERO CRD42020210825

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