A comparison of Monte Carlo-based Bayesian parameter estimation methods for stochastic models of genetic networks

Population-level effectiveness of pre-exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data

INTRODUCTION

HIV pre-exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population-level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013-2021.

METHODS

We used an agent-based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID-19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual-level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post-exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free-of-charge), and improving retention.

RESULTS

Over 2013-2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3-0.6) to 0.2 (90% CrI: 0.1-0.2) per 100 person-years. PrEP coverage among HIV-negative MSM remained low until 2015 (<1%). Afterwards, coverage increased to a maximum of 10% of all HIV-negative MSM, or about 16% of the 62% PrEP-eligible HIV-negative MSM in 2020. Over 2015-2021, PrEP averted an estimated 20% (90% CrI: 11%-30%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%-42%) of HIV acquisitions from 2015-2021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV-negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%-70%) of HIV acquisitions from 2015 to 2021.

CONCLUSIONS

PrEP reduced population-level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition.

Formation Mechanism of Microbial Diversity in Artificial Intelligence Devices due to Intermediate Disturbance by Low-Dose UV Radiation for Complementary Medicine

The development of artificial intelligence devices in the complementary medicine field is rapid and the surface microbial diversity pollution was found with periodic low-dose ultraviolet radiation (LDUVR). Since artificial intelligence devices do not have enough different types of substrates for microbial communities, it is unclear how the great microbial diversity can emerge and persist, as this clearly defies the competitive exclusion principle of ecology. In this study, the 5 most common genera in the artificial intelligence devices, Escherichia, Pseudomonas, Streptococcus, Staphylococcus and Aeromonas have been sampled without and with periodic LDUVR, respectively. A new hypothesis was put up to clarify the construction and maintenance process of high microbiological diversity in artificial intelligence devices by comparing and evaluating the variations between the dynamic response characteristics of their relative abundances in the two scenarios as follows: the periodic LDUVR can be regarded as an adverse factor with intermediate disturbance, causing stronger microbial stochastic growth responses (SGR) which would inevitably give rise to stronger random variation of the other important processes tightly correlated with SGR, such as intra- and interspecific competition process, and substrates production and consumption process, which could effectively diminish the auto- and cross-correlation of stochastic processes of microbial populations, alleviating the intra- and inter-specific competitions. In artificial intelligence devices with LDUVR, these crucial succession processes can propel the microbial communities to generate and sustain a high species diversity. Finally, thorough Monte Carlo simulations were used to thoroughly confirm the idea. This research can build the theoretical groundwork, offer fresh viewpoints, and suggest potential microbial prevention strategies for the succession of microbial communities in LDUVR.