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. 2016 Dec 15;214(12):1800-1807.
doi: 10.1093/infdis/jiw223. Epub 2016 Jul 14.

Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States

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Free PMC article

Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States

Samuel M Jenness et al. J Infect Dis. .
Free PMC article

Abstract

Background: Preexposure prophylaxis (PrEP) is effective for preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) within trial settings. Population impact will depend on clinical indications for PrEP initiation, coverage levels, and drug adherence. No modeling studies have estimated the impact of clinical practice guidelines for PrEP issued by the Centers for Disease Control and Prevention (CDC).

Methods: Mathematical models of HIV transmission among MSM were used to estimate the percentage of infections averted (PIA) and the number needed to treat (NNT) under behavioral indications of the CDC's PrEP guidelines. We modeled the contribution of these indications while varying treatment coverage and adherence.

Results: At 40% coverage of indicated MSM over the next decade, application of CDC guidelines would avert 1162 infections per 100 000 person-years, 33.0% of expected infections. The predicted NNT for the guidelines would be 25. Increasing coverage and adherence jointly raise the PIA, but reductions to the NNT were associated with better adherence only.

Conclusions: Implementation of CDC PrEP guidelines would result in strong and sustained reductions in HIV incidence among MSM in the United States. The guidelines strike a good balance between epidemiological impact (PIA) and efficiency (NNT) at plausible scale-up levels. Adherence counseling could maximize public health investment in PrEP by decreasing the NNT.

Keywords: HIV; clinical guidelines; mathematical model; men who have sex with men; preexposure prophylaxis; sexual network.

Figures

Figure 1.
Figure 1.
Cumulative percentage of infections averted (red line) and 95% credible intervals (pink band) over 10 years of a preexposure prophylaxis (PrEP) intervention among men who have sex with men, assuming that 40% of those with behavioral indications started PrEP and 61.9% of those receiving PrEP are highly adherent.
Figure 2.
Figure 2.
Box plots of the percentage of infections averted and number needed to treat to prevent 1 new infection by the individual behavioral indications (1a–3b; blue) and joint guideline scenarios (J1–J3; red) outlined in Table 1. Boxes indicate interquartile ranges; whiskers, 95% credible intervals for outcomes across all 250 simulations for each scenario.
Figure 3.
Figure 3.
Percentage of infections averted (PIA) and number needed to treat (NNT) under the joint clinical practice model (scenario J2), with varying coverage (proportion of men who have sex with men with behavioral indications who start preexposure prophylaxis) and adherence (proportion receiving who maintain a high-adherence profile, ie, taking ≥4 doses per week). Results are cumulative outcomes over 10 years of the simulations.

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