TY - JOUR
T1 - Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis
AU - Rozhnova, Ganna
AU - Heijne, Janneke
AU - Bezemer, Daniela
AU - van Sighem, Ard
AU - Presanis, Anne
AU - De Angelis, Daniela
AU - Kretzschmar, Mirjam
N1 - Funding Information:
The authors gratefully acknowledge funding by the Aidsfonds Netherlands, grant number 2013030. The authors are thankful to Prof Roel Coutinho for valuable comments on the article. A.P. and D.D.A. were supported by the Medical Research Council (Unit programme number MC_UU_00002/11).
Publisher Copyright:
Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2018/11/13
Y1 - 2018/11/13
N2 - OBJECTIVE: Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination.DESIGN AND METHODS: We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use.RESULTS: At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%.CONCLUSION: PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.
AB - OBJECTIVE: Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination.DESIGN AND METHODS: We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use.RESULTS: At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%.CONCLUSION: PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.
KW - HIV elimination
KW - HIV prevalence
KW - mathematical modeling
KW - men who have sex with men
KW - preexposure prophylaxis coverage
KW - Preexposure prophylaxis coverage
KW - Men who have sex with men
KW - Preexposure prophylaxis
KW - Mathematical modeling
UR - http://www.scopus.com/inward/record.url?scp=85055844224&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000002050
DO - 10.1097/QAD.0000000000002050
M3 - Article
C2 - 30379687
SN - 0269-9370
VL - 32
SP - 2615
EP - 2623
JO - AIDS
JF - AIDS
IS - 17
ER -