Estimated Impact of Targeted Pre-Exposure Prophylaxis: Strategies for Men Who Have Sex with Men in the United States

Richard A. Elion, Mina Kabiri, Kenneth H. Mayer, David A. Wohl, Joshua Cohen, Anne C. Beaubrun and Frederick L. Altice
Additional contact information
Richard A. Elion: George Washington University School of Medicine, Washington, DC 20009, USA
Mina Kabiri: Precision Health Economics, Los Angeles, CA 90025, USA
Kenneth H. Mayer: The Fenway Institute, Harvard Medical School, Boston, MA 02215, USA
David A. Wohl: Chapel Hill School of Medicine, The University of North Carolina, Chapel Hill, NC 27514, USA
Joshua Cohen: Tufts University Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA
Anne C. Beaubrun: Gilead Sciences, Foster City, CA 94404, USA
Frederick L. Altice: Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA

IJERPH, 2019, vol. 16, issue 9, 1-14

Abstract: Pre-exposure prophylaxis (PrEP) effectively reduces human immunodeficiency virus (HIV) transmission. We aimed to estimate the impact of different PrEP prioritization strategies among Black and Latino men who have sex with men (MSM) in the United States, populations most disproportionately affected by HIV. We developed an agent-based simulation to model the HIV epidemic among MSM. Individuals were assigned an HIV incidence risk index (HIRI-MSM) based on their sexual behavior. Prioritization strategies included PrEP use for individuals with HIRI-MSM ≥10 among all MSM, all Black MSM, young (≤25 years) Black MSM, Latino MSM, and young Latino MSM. We estimated the number needed to treat (NNT) to prevent one HIV infection, reductions in prevalence and incidence, and subsequent infections in non-PrEP users avoided under these strategies over 5 years (2016–2020). Young Black MSM eligible for PrEP had the lowest NNT (NNT = 10) followed by all Black MSM (NNT = 33) and young Latino MSM (NNT = 35). All Latino MSM and all MSM had NNT values of 63 and 70, respectively. Secondary infection reduction with PrEP was the highest among young Latino MSM (53.2%) followed by young Black MSM (37.8%). Targeting all MSM had the greatest reduction in prevalence (14.7% versus 2.9%–3.9% in other strategies) and incidence (49.4% versus 9.4%–13.9% in other groups). Using data representative of the United States MSM population, we found that a strategy of universal PrEP use by MSM was most effective in reducing HIV prevalence and incidence of MSM. Targeted use of PrEP by Black and Latino MSM, however, especially those ≤25 years, had the greatest impact on HIV prevention.

Keywords: pre-exposure prophylaxis (PrEP); men who have sex with men (MSM); agent-based model; simulation; human immunodeficiency virus (HIV); number needed to treat (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/16/9/1592/pdf (application/pdf)
https://www.mdpi.com/1660-4601/16/9/1592/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:16:y:2019:i:9:p:1592-:d:228778

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().