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Hamilton DT, Goodreau SM, Jenness SM, Sullivan PS, Wang LY, Dunville RL, Barrios LC, Rosenberg ES. Potential Impact of HIV Preexposure Prophylaxis Among Black and White Adolescent Sexual Minority Males. Am J Public Health 2018; 108:S284-S291. [PMID: 30383415 PMCID: PMC6215365 DOI: 10.2105/ajph.2018.304471] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the potential impact of preexposure prophylaxis (PrEP) on the HIV epidemic among Black and White adolescent sexual minority males (ASMM). METHODS We used a network model and race-specific data from recent trials to simulate HIV transmission among a population of Black and White 13- to 18-year-old ASMM over 20 years. We estimated the number of infections prevented (impact) and the number needed to treat to prevent an infection (efficiency) under multiple coverage and adherence scenarios. RESULTS At modeled coverage and adherence, PrEP could avert 3% to 20% of infections among Black ASMM and 8% to 51% among White ASMM. A larger number, but smaller percentage, of infections were prevented in Black ASMM in all scenarios examined. PrEP was more efficient among Black ASMM (number needed to treat to avert an infection = 25-32) compared with White ASMM (146-237). CONCLUSIONS PrEP can reduce HIV incidence among both Black and White ASMM but is far more efficient for Black ASMM because of higher incidence. Public Health Implications. Black ASMM communities suffer disproportionate HIV burden; despite imperfect adherence, PrEP programs could prevent HIV efficiently in these communities.
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Affiliation(s)
- Deven T Hamilton
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Steven M Goodreau
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Samuel M Jenness
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Patrick S Sullivan
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Li Yan Wang
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Richard L Dunville
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Lisa C Barrios
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Eli S Rosenberg
- Deven T. Hamilton is with the Center for Studies in Demography and Ecology and Steven M. Goodreau is with the Department of Anthropology, University of Washington, Seattle. Samuel M. Jenness and Patrick S. Sullivan are with the Department of Epidemiology, Emory University, Atlanta, GA. Li Yan Wang, Richard L. Dunville, and Lisa C. Barrios are with the Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA. Eli S. Rosenberg is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
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Goodreau SM, Hamilton DT, Jenness SM, Sullivan PS, Valencia RK, Wang LY, Dunville RL, Barrios LC, Rosenberg ES. Targeting Human Immunodeficiency Virus Pre-Exposure Prophylaxis to Adolescent Sexual Minority Males in Higher Prevalence Areas of the United States: A Modeling Study. J Adolesc Health 2018; 62:311-319. [PMID: 29248392 PMCID: PMC5818296 DOI: 10.1016/j.jadohealth.2017.09.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/31/2017] [Accepted: 09/21/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Pre-exposure prophylaxis (PrEP) is an effective and safe intervention to prevent human immunodeficiency virus (HIV) transmission in men who have sex with men; current Centers for Disease Control and Prevention guidelines indicate its use among high-risk adults. Adolescent sexual minority males (ASMM) also have significant HIV risk, but implementation strategies are likely to differ for this population. We aimed to estimate impact and efficiency of PrEP for ASMM in higher prevalence US settings, using a variety of implementation strategies and assumptions about coverage, adherence, and background prevalence. METHODS We develop a stochastic, dynamic, network-based model, parametrized using numerous ASMM behavioral and clinical data sources. We simulate 10 years with and without PrEP, comparing percent of incident infections averted (impact) and number of person-years on PrEP per infection averted (efficiency). RESULTS Our main scenario (PrEP for 16- to 18-year-old ASMM, initiating PrEP 6 months after first anal intercourse, 40% coverage, adherence profiles from the ATN 113 trial; 2.9% background HIV prevalence among ASMM) prevents 27.8% of infections, with 38 person-years on PrEP per infection averted. Expanding implementation to cover younger ages or earlier initiation has small effects on impact and efficiency. Targeting highest risk ASMM increases efficiency, but requires querying sexual histories. Across levels examined, coverage and adherence do not have major impacts on efficiency, whereas background prevalence does. CONCLUSIONS PrEP can have a large impact on HIV incidence among ASMM in the United States, especially in settings with high prevalence. However, willingness of, and support for, providers will be central to achieving the coverage needed to make this a success.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington; Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington.
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington
| | | | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Atlanta, Georgia; Department of Global Health, Emory University, Atlanta, Georgia
| | | | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard L Dunville
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Barrios
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York
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Individual HIV Risk versus Population Impact of Risk Compensation after HIV Preexposure Prophylaxis Initiation among Men Who Have Sex with Men. PLoS One 2017; 12:e0169484. [PMID: 28060881 PMCID: PMC5218403 DOI: 10.1371/journal.pone.0169484] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Risk compensation (RC) could reduce or offset the biological prevention benefits of HIV preexposure prophylaxis (PrEP) among those at substantial risk of infection, including men who have sex with men (MSM). We investigated the potential extent and causal mechanisms through which RC could impact HIV transmission at the population and individual levels. METHODS Using a stochastic network-based mathematical model of HIV transmission dynamics among MSM in the United States, we simulated RC as a reduction in the probability of condom use after initiating PrEP, with heterogeneity by PrEP adherence profiles and partnership type in which RC occurred. Outcomes were changes to population-level HIV incidence and individual-level acquisition risk. RESULTS When RC was limited to MSM highly/moderately adherent to PrEP, 100% RC (full replacement of condoms) resulted in a 2% relative decline in incidence compared to no RC, but an 8% relative increase in infection risk for MSM on PrEP. This resulted from confounding by indication: RC increased the number of MSM indicated for PrEP as a function of more condomless anal intercourse among men otherwise not indicated for PrEP; this led to an increased PrEP uptake and subsequent decline in incidence. CONCLUSIONS RC is unlikely to decrease the prevention impact of PrEP, and in some cases RC may be counterintuitively beneficial at the population level. This depended on PrEP uptake scaling with behavioral indications. Due to the increased acquisition risk associated with RC, however, clinicians should continue to support PrEP as a supplement rather than replacement of condoms.
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