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Yin F, She Y, Pan Y, Tang X, Hou H, Wu J. Hot-topics cross-propagation and opinion-transfer dynamics in the Chinese Sina-microblog social media: a modeling study. J Theor Biol 2023; 566:111480. [PMID: 37003482 DOI: 10.1016/j.jtbi.2023.111480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/15/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
On social media platforms, hot topics often contain several pieces of related information that can influence internet users, generating either positive or negative opinion orientation. Some of them will choose to retain or change their original opinions after exposure to multiple related messages. To describe the opinion-transfer transient and collective behaviors in this scenario, this paper proposes an opinion-transfer susceptible-forwarding-immunized (OT-SFI) information cross-propagation model. Real multiple information in messages with opinions obtained from the Chinese Sina microblog is used for data fitting to illustrate how model parameters can be estimated and used to predict the accumulative numbers of users with a particular view. The study attempts to relate changes in group views in the network to initial opinion distribution and individuals' opinion choices at the macro level. Furthermore, the model parameters at the micro level are used to measure the probability of "retention" and "reversal" of views in events, as well as the extent to which the masses are influenced by new information views. The result illustrates that the viewpoint distribution of the initial message and the opinion selection of the new message opinion leaders play crucial roles in promoting attention to the topic and driving for a desired collective opinion.
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Affiliation(s)
- Fulian Yin
- College of Information and Communication Engineering, Communication University of China, Beijing, 100024, PR China
| | - Yuwei She
- College of Information and Communication Engineering, Communication University of China, Beijing, 100024, PR China
| | - Yanyan Pan
- College of Information and Communication Engineering, Communication University of China, Beijing, 100024, PR China
| | - Xinyi Tang
- College of Information and Communication Engineering, Communication University of China, Beijing, 100024, PR China
| | - Haotong Hou
- College of Information and Communication Engineering, Communication University of China, Beijing, 100024, PR China
| | - Jianhong Wu
- Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J1P3, Canada.
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2
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Yin F, Tang X, Liang T, Huang Y, Wu J. External intervention model with direct and indirect propagation behaviors on social media platforms. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:11380-11398. [PMID: 36124595 DOI: 10.3934/mbe.2022530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A significant distinction between the COVID-19 pandemic and previous pandemics is the significant role of social media platforms in shaping public adherence to non-pharmaceutical interventions and vaccine acceptance. However, with the recurrence of the epidemic, the conflict between epidemic prevention and production recovery has become increasingly prominent on social media. To help design effective communication strategies to guide public opinion, we propose a susceptible-forwarding-immune pseudo-environment (SFI-PE) dynamic model for understanding the environment with direct and indirect propagation behaviors. Then, we introduce a system with external interventions for direct and indirect propagation behaviors, termed the macro-controlled SFI-PE (M-SFI-PE) model. Based on the numerical analyses that were performed using actual data from the Chinese Sina microblogging platform, the data fitting results prove our models' effectiveness. The research grasps the law of the new information propagation paradigm, and our work bridges the gap between reality and theory in information interventions.
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Affiliation(s)
- Fulian Yin
- State Key Laboratory of Media Convergence and Communication, Communication University of China, Beijing 100024, China
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Xinyi Tang
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Tongyu Liang
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Yanjing Huang
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Jianhong Wu
- Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, Toronto M3J1P3, Canada
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3
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Sentiment mutation and negative emotion contagion dynamics in social media: A case study on the Chinese Sina Microblog. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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4
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Jafari M, Kheiri H. Free terminal time optimal control of a fractional-order model for the HIV/AIDS epidemic. INT J BIOMATH 2021. [DOI: 10.1142/s179352452250022x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, we present a fractional model for the HIV/AIDS epidemic and incorporate into the model control parameters of pre-exposure prophylaxis (PrEP), behavioral change and antiretroviral therapy (ART) aimed at controlling the spread of diseases. We prove the local and global asymptotic stability of disease-free and endemic equilibria of the model. We present a general fractional optimal control problem (FOCP) with free terminal time and develop the Adapted Forward-Backward Sweep method for numerical solving of the FOCP. Necessary conditions for a state/control/terminal time triplet to be optimal are obtained. The results show that the use of all controls increases the life expectancy of HIV-treated patients with ART and remarkably increases the number of people undergoing PrEP and changing their sexual habits. Also, when the derivative order [Formula: see text] ([Formula: see text]) limits to 1, the value of optimal terminal time increases while the value of objective functional decreases.
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Affiliation(s)
- Mohsen Jafari
- Faculty of Mathematical Sciences, University of Tabriz, Tabriz, Iran
| | - Hossein Kheiri
- Faculty of Mathematical Sciences, University of Tabriz, Tabriz, Iran
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Yin F, Pang H, Zhu L, Liu P, Shao X, Liu Q, Wu J. The role of proactive behavior on COVID-19 infordemic in the Chinese Sina-Microblog: a modeling study. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:7389-7401. [PMID: 34814254 DOI: 10.3934/mbe.2021365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In order to avoid forming an information cocoon, the information propagation of COVID-19 is usually created through the action of "proactive search", an important behavior other than "reactive follow". This behavior has been largely ignored in modeling information dynamics. Here, we propose to fill in this gap by proposing a proactive-reactive susceptible-discussing-immune (PR-SFI) model to describe the patterns of co-propagation on social networks. This model is based on the forwarding quantity and takes into account both proactive search and reactive follow behaviors. The PR-SFI model is parameterized by data fitting using real data of COVID-19 related topics in the Chinese Sina-Microblog, and the model is calibrated and validated using the prediction accuracy of the accumulated forwarding users. Our sensitivity analysis and numerical experiments provide insights about optimal strategies for public health emergency information dissemination.
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Affiliation(s)
- Fulian Yin
- State Key Laboratory of Media Convergence and Communication, Communication University of China, Beijing, 100024, China
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Hongyu Pang
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Lingyao Zhu
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Peiqi Liu
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Xueying Shao
- College of Information and Communication Engineering, Communication University of China, Beijing 100024, China
| | - Qingyu Liu
- The third construction CO.LTD of China construction third engineering bureau Beijing, Beijing 100024, China
| | - Jianhong Wu
- Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, Toronto M3J1P3, Canada
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6
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Whiteley L, Craker L, Sun S, Tarantino N, Hershkowitz D, Moskowitz J, Arnold T, Haubrick K, Olsen E, Mena L, Brown LK. Factors associated with PrEP adherence among MSM living in Jackson, Mississippi. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2021; 20:246-261. [PMID: 35662802 PMCID: PMC9162088 DOI: 10.1080/15381501.2021.1956666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 05/05/2023]
Abstract
Understanding the determinants of pre-exposure prophylaxis (PrEP) adherence is integral to reducing HIV incidence in the United States, especially for those at highest risk. To this end, the present study explored demographic, psychosocial, and behavioral factors related to adherence among 43 Southern, predominately Black, men who have sex with men (MSM). During the study months, 46% of the sample reported being nonadherent to PrEP. Those with more sexual partners (p = .05), greater self-efficacy for taking PrEP (p = .03), and those who felt condoms were less important (p = .02), were more likely to be adherent to PrEP at six-month follow-up. Further interventions that consider perceived sexual risk, condom use, and adherence self-efficacy are needed to improve PrEP adherence among Southern MSM.
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Affiliation(s)
- Laura Whiteley
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Lacey Craker
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Shufang Sun
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - Jesse Moskowitz
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Trisha Arnold
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kayla Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Elizabeth Olsen
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Larry K. Brown
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Yin F, Pang H, Xia X, Shao X, Wu J. COVID-19 information contact and participation analysis and dynamic prediction in the Chinese Sina-microblog. PHYSICA A 2021; 570:125788. [PMID: 33551542 PMCID: PMC7845521 DOI: 10.1016/j.physa.2021.125788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/16/2020] [Indexed: 06/12/2023]
Abstract
The outbreak of a novel coronavirus (COVID-19) aroused great public opinion in the Chinese Sina-microblog. To help in designing effective communication strategies during a major public health emergency, we analyze the real data of COVID-19 information and propose a comprehensive susceptible-reading-forwarding-immune (SRFI) model to understand the patterns of key information propagation considering both public contact and participation. We develop the SRFI model, based on the public reading quantity and forwarding quantity that denote contact and participation respectively, and take into account the behavior that users may re-enter another related topic during the attention phase or the participation phase freely. Data fitting using the real data of both reading quantity and forwarding quantity obtained from Chinese Sina-microblog can parameterize the model to make an accurate prediction of the COVID-19 public opinion trend until the next major news item occurs, and the sensitivity analysis provides the basic strategies for communication.
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Affiliation(s)
- Fulian Yin
- College of Information and Communication Engineering, Beijing, 100024, PR China
| | - Hongyu Pang
- College of Information and Communication Engineering, Beijing, 100024, PR China
| | - Xinyu Xia
- College of Information and Communication Engineering, Beijing, 100024, PR China
| | - Xueying Shao
- College of Information and Communication Engineering, Beijing, 100024, PR China
| | - Jianhong Wu
- Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J1P3, Canada
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Yin F, Shao X, Ji M, Wu J. Quantifying the Influence of Delay in Opinion Transmission of COVID-19 Information Propagation: Modeling Study. J Med Internet Res 2021; 23:e25734. [PMID: 33529153 PMCID: PMC7886376 DOI: 10.2196/25734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/29/2020] [Accepted: 01/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background In a fast-evolving public health crisis such as the COVID-19 pandemic, multiple pieces of relevant information can be posted sequentially on a social media platform. The interval between subsequent posting times may have a different impact on the transmission and cross-propagation of the old and new information that results in a different peak value and a final size of forwarding users of the new information, depending on the content correlation and whether the new information is posted during the outbreak or quasi–steady-state phase of the old information. Objective This study aims to help in designing effective communication strategies to ensure information is delivered to the maximal number of users. Methods We developed and analyzed two classes of susceptible-forwarding-immune information propagation models with delay in transmission to describe the cross-propagation process of relevant information. A total of 28,661 retweets of typical information were posted frequently by each opinion leader related to COVID-19 with high influence (data acquisition up to February 19, 2020). The information was processed into discrete points with a frequency of 10 minutes, and the real data were fitted by the model numerical simulation. Furthermore, the influence of parameters on information dissemination and the design of a publishing strategy were analyzed. Results The current epidemic outbreak situation, epidemic prevention, and other related authoritative information cannot be timely and effectively browsed by the public. The ingenious use of information release intervals can effectively enhance the interaction between information and realize the effective diffusion of information. We parameterized our models using real data from Sina Microblog and used the parameterized models to define and evaluate mutual attractiveness indexes, and we used these indexes and parameter sensitivity analyses to inform optimal strategies for new information to be effectively propagated in the microblog. The results of the parameter analysis showed that using different attractiveness indexes as the key parameters can control the information transmission with different release intervals, so it is considered as a key link in the design of an information communication strategy. At the same time, the dynamic process of information was analyzed through index evaluation. Conclusions Our model can carry out an accurate numerical simulation of information at different release intervals and achieve a dynamic evaluation of information transmission by constructing an indicator system so as to provide theoretical support and strategic suggestions for government decision making. This study optimizes information posting strategies to maximize communication efforts for delivering key public health messages to the public for better outcomes of public health emergency management.
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Affiliation(s)
- Fulian Yin
- College of Information and Communication Engineering, Communication University of China, Beijing, China
| | - Xueying Shao
- College of Information and Communication Engineering, Communication University of China, Beijing, China
| | - Meiqi Ji
- College of Information and Communication Engineering, Communication University of China, Beijing, China
| | - Jianhong Wu
- Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, Toronto, ON, Canada
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Modeling and analyzing cross-transmission dynamics of related information co-propagation. Sci Rep 2021; 11:268. [PMID: 33432014 PMCID: PMC7801523 DOI: 10.1038/s41598-020-79503-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022] Open
Abstract
The dissemination of one public hot event is usually affected by some related information, and the implication of co-propagation by different information is critical for the integrated analysis. To help in designing effective communication strategies during the whole event, we propose the cross-transmission susceptible-forwarding-immune (CT-SFI) model to describe the dynamics of co-propagation particularly with focus on the cross-transmission effects. This model is based on the forwarding quantity and takes into account the behavior that users may have a strong attraction or continuous attraction within or without an active time after contacting one information. Data fitting using the real data of Chinese Sina-microblog can accurately parameterize the model and parameter sensitivity analysis gives some strategies for co-propagation.
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Berner-Rodoreda A, Geldsetzer P, Bärnighausen K, Hettema A, Bärnighausen T, Matse S, McMahon SA. "It's hard for us men to go to the clinic. We naturally have a fear of hospitals." Men's risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini. PLoS One 2020; 15:e0237427. [PMID: 32966307 PMCID: PMC7510987 DOI: 10.1371/journal.pone.0237427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 07/27/2020] [Indexed: 01/10/2023] Open
Abstract
Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused on men who have sex with women. We present findings from a mixed-methods study in Eswatini, the country with the highest HIV prevalence in the world (27%). Our findings are based on risk assessments, in-depth interviews and focus-group discussions which describe men’s motivations for taking up or declining PrEP. Quantitatively, men self-reported starting PrEP because they had multiple or sero-discordant partners or did not know the partner’s HIV-status. Men’s self-perception of risk was echoed in the qualitative data, which revealed that the hope of facilitated sexual performance or relations, a preference for pills over condoms and the desire to protect themselves and others also played a role for men to initiate PrEP. Trust and mistrust and being able or unable to speak about PrEP with partner(s) were further considerations for initiating or declining PrEP. Once on PrEP, men’s sexual behavior varied in terms of number of partners and condom use. Men viewed daily pill-taking as an obstacle to starting PrEP. Side-effects were a major reason for men to discontinue PrEP. Men also worried that taking anti-retroviral drugs daily might leave them mistaken for a person living with HIV, and viewed clinic-based PrEP education and initiation processes as a further obstacle. Given that men comprise only 29% of all PrEP users in Eswatini, barriers to men’s uptake of PrEP will need to be addressed, in terms of more male-friendly services as well as trialing community-based PrEP education and service delivery.
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Affiliation(s)
| | - Pascal Geldsetzer
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Kate Bärnighausen
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Anita Hettema
- Clinton Health Access Initiative Swaziland, Mbabane, Eswatini
| | - Till Bärnighausen
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Shannon A. McMahon
- Institute of Global Health, Ruprecht-Karls-Universität, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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11
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Whiteley L, Olsen E, Mena L, Haubrick K, Craker L, Hershkowitz D, Brown LK. A Mobile Gaming Intervention for Persons on Pre-Exposure Prophylaxis: Protocol for Intervention Development and Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18640. [PMID: 32924954 PMCID: PMC7522735 DOI: 10.2196/18640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background In the United States, young minority men who have sex with men (MSM) are the most likely to become infected with HIV. Pre-exposure prophylaxis (PrEP) is an efficacious and promising prevention strategy. However, PrEP’s safety and effectiveness can be greatly compromised by suboptimal adherence to treatment. To maximize the positive impact of PrEP, it is necessary to combine its prescription with cost-effective behavioral interventions that promote adherence and decrease HIV risk behaviors. In this project, we developed a theoretically informed app/gaming intervention to engage young MSM in learning information, practicing behaviors, and improving motivation for HIV preventative behaviors and PrEP adherence. Objective The goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior. Methods This study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60). Results Institutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing. Conclusions This app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings. Trial Registration ClinicalTrials.gov RCT02611362; https://tinyurl.com/y65gkuwr International Registered Report Identifier (IRRID) DERR1-10.2196/18640
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Elizabeth Olsen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Kayla Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Lacey Craker
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Dylan Hershkowitz
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Larry K Brown
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
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12
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Analysis and optimal control of an HIV model based on CD4 count. J Math Biol 2020; 81:209-241. [PMID: 32601724 DOI: 10.1007/s00285-020-01508-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/12/2019] [Indexed: 10/24/2022]
Abstract
A non-linear mechanistic model for the transmission dynamics of HIV/AIDS is developed and analyzed. The model classified the infected individuals based on their CD4 count level. Furthermore, education campaign, voluntary testing and counseling and treatment are considered as intervention strategies for controlling the disease. The analysis of the model reveals that imperfect public enlightenment campaign can induce backward bifurcation. It has been shown that when public enlightenment campaign is [Formula: see text] effective, the disease free equilibrium is globally asymptotically stable for [Formula: see text], whereas for [Formula: see text] the global stability of the endemic equilibrium is proved only in a special case. Time dependent controls of the intervention strategies mentioned above are incorporated into the model and the optimal control strategies with minimal implementation cost are identified. In addition, cost effectiveness analysis in the form of incremental cost effectiveness ratio is carried-out to identify the most cost effective strategies. The results suggest that out of the three non dominated strategies, the strategy of educating the newly entrants only or combination of newly entrants and susceptible individuals is very cost effective using per capita GDP of Nigeria as at 2018. However, the choice of which strategy to implement depends on budgetary allocation and resource availability.
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Yin F, Xia X, Song N, Zhu L, Wu J. Quantify the role of superspreaders -opinion leaders- on COVID-19 information propagation in the Chinese Sina-microblog. PLoS One 2020; 15:e0234023. [PMID: 32511260 PMCID: PMC7279582 DOI: 10.1371/journal.pone.0234023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUD Effective communication of accurate information through social media constitutes an important component of public health interventions in modern time, when traditional public health approaches such as contact tracing, quarantine and isolation are among the few options for the containing the disease spread in the population. The success of control of COVID-19 outbreak started from Wuhan, the capital city of Hubei Province of China relies heavily on the resilience of residents to follow public health interventions which induce substantial interruption of social-economic activities, and evidence shows that opinion leaders have been playing significant roles in the propagation of epidemic information and public health policy and implementations. METHODS We design a mathematical model to quantify the roles of information superspreaders in single specific information which outbreaks rapidly and usually has a short duration period, and to examine the information propagation dynamics in the Chinese Sina-microblog. Our opinion-leader susceptible-forwarding-immune (OL-SFI) model is formulated to track the temporal evolution of forwarding quantities generated by opinion leaders and normal users. RESULTS Data fitting from the real data of COVID-19 obtained from Chinese Sina-microblog can identify the different contact rates and forwarding probabilities (and hence calculate the basic information forwarding reproduction number of superspreaders), and can be used to evaluate the roles of opinion leaders in different stages of the information propagation and the outbreak unfolding. CONCLUSIONS The parameterized model can be used to nearcast the information propagation trend, and the model-based sensitivity analysis can help to explore important factors for the roles of opinion leaders.
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Affiliation(s)
- Fulian Yin
- College of Information and Communication Engineering, Communication University of China, Beijing, PR China
| | - Xinyu Xia
- College of Information and Communication Engineering, Communication University of China, Beijing, PR China
| | - Nan Song
- College of Information and Communication Engineering, Communication University of China, Beijing, PR China
| | - Lingyao Zhu
- College of Information and Communication Engineering, Communication University of China, Beijing, PR China
| | - Jianhong Wu
- Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, Toronto, Canada
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14
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Hansson D, Strömdahl S, Leung KY, Britton T. Introducing pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Sweden: insights from a mathematical pair formation model. BMJ Open 2020; 10:e033852. [PMID: 32029492 PMCID: PMC7045051 DOI: 10.1136/bmjopen-2019-033852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Since 2017, the Public Health Agency of Sweden recommends that pre-exposure prophylaxis (PrEP) for HIV should be offered to high-risk individuals, in particular to men who have sex with men (MSM). The objective of this study is to develop a mathematical model investigating the effect of introducing PrEP to MSM in Sweden. DESIGN A pair formation model, including steady and casual sex partners, is developed to study the impact of introducing PrEP. Two groups are included in the model: sexually high active MSM and sexually low active MSM. Three mixing assumptions between the groups are considered. SETTING A gay-friendly MSM HIV/sexually transmitted infection testing clinic in Stockholm, Sweden. This clinic started offering PrEP to MSM in October 2018. PARTICIPANTS The model is calibrated according to detailed sexual behaviour data gathered in 2015 among 403 MSM. RESULTS By targeting sexually high active MSM, a PrEP coverage of 3.5% of the MSM population (10% of all high actives) would result in the long-term HIV prevalence to drop considerably (close to 0%). While targeting only low actives would require a PrEP coverage of 35% for a similar reduction. The main effect of PrEP is the reduced susceptibility, whereas the increased HIV testing rate (every third month) among PrEP users plays a lesser role. CONCLUSIONS To create a multifaceted picture of the effects of interventions against HIV, we need models that include the different stages of HIV infection and real-world data on detailed sexual behaviour to calibrate the mathematical models. Our findings conclude that targeting HIV high-risk individuals, within HIV risk populations such as MSM, with PrEP programmes could greatly decrease the long-term HIV prevalence in Sweden. Therefore, risk stratification of individuals is of importance in PrEP implementation programmes, to ensure optimising the effect and cost-effectiveness of such programmes.
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Affiliation(s)
- Disa Hansson
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Susanne Strömdahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Ka Yin Leung
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Tom Britton
- Department of Mathematics, Stockholm University, Stockholm, Sweden
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van Vliet MM, Hendrickson C, Nichols BE, Boucher CAB, Peters RPH, van de Vijver DAMC. Epidemiological impact and cost-effectiveness of providing long-acting pre-exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study. J Int AIDS Soc 2019; 22:e25427. [PMID: 31855323 PMCID: PMC6922023 DOI: 10.1002/jia2.25427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/08/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Although pre-exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub-Saharan Africa, likely due to non-adherence. Adherence may be improved with the use of injectable long-acting PrEP methods currently being developed. We hypothesize that providing long-acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to PrEP, result in a reduction of new HIV infections, and be a relatively easy-to-reach target population. In this modelling study, we assessed the epidemiological impact and cost-effectiveness of providing long-acting PrEP to injectable contraceptive users in Limpopo, South Africa. METHODS We developed a deterministic mathematical model calibrated to the HIV epidemic in Limpopo. Long-acting PrEP was provided to 50% of HIV negative injectable contraceptive users in 2018 and scaled-up over two years. We estimated the number of HIV infections that could be averted by 2030 and the drug price of long-acting PrEP for which this intervention would be cost-effective over a time horizon of 40 years, from a healthcare payer perspective. In the base-case scenario we assumed long-acting PrEP is 75% effective in preventing HIV infections and 85% of infected individuals are on antiretroviral drug therapy (ART) by 2030. In sensitivity analyses we adjusted PrEP effectiveness and ART coverage. Costs between $519 and $1119 per disability-adjusted life-year (DALY) averted were considered potentially cost-effective, and <$519 as cost-effective. RESULTS Without long-acting injectable PrEP, 224,000 (interquartile range 176,000 to 271,000) new infections will occur by 2030; use of long-acting injectable PrEP could prevent 21,000 (17,000 to 26,000) or 9.8% (8.9% to 10.6%) new HIV infections by 2030 (including 6000 (4000 to 7000) in men). Long-acting PrEP would prevent 34,000 (29,000 to 39,000) or 12,000 (8000 to 15,000) at 75% and 95% ART coverage by 2030 respectively. To be considered potentially cost-effective the annual long-acting PrEP drug price should be <$16, and/or ART coverage remains at <85% in 2030. CONCLUSIONS Providing long-acting PrEP to injectable contraceptive users in Limpopo is only potentially cost-effective when long-acting PrEP drug prices are low. If low prices are not feasible, providing long-acting PrEP only to women at high risk of HIV infection will become important.
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Affiliation(s)
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Brooke E Nichols
- Health Economics and Epidemiology Research OfficeDepartment of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | | | - Remco PH Peters
- Department of Medical MicrobiologySchool of Public Health & Primary Care (CAPHRI)Maastricht University Medical CentreMaastrichtThe Netherlands
- Anova Health InstituteJohannesburgSouth Africa
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16
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Case KK, Gomez GB, Hallett TB. The impact, cost and cost-effectiveness of oral pre-exposure prophylaxis in sub-Saharan Africa: a scoping review of modelling contributions and way forward. J Int AIDS Soc 2019; 22:e25390. [PMID: 31538407 PMCID: PMC6753289 DOI: 10.1002/jia2.25390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) is a new form of HIV prevention being considered for inclusion in national prevention portfolios. Many mathematical modelling studies have been undertaken that speak to the impact, cost and cost-effectiveness of PrEP programmes. We assess the available evidence from mathematical modelling studies to inform programme planning and policy decision making for PrEP and further research directions. METHODS We conducted a scoping review of the published modelling literature. Articles published in English which modelled oral PrEP in sub-Saharan Africa, or non-specific settings with relevance to generalized HIV epidemic settings, were included. Data were extracted for the strategies of PrEP use modelled, and the impact, cost and cost-effectiveness of PrEP for each strategy. We define an algorithm to assess the quality and relevance of studies included, summarize the available evidence and identify the current gaps in modelling. Recommendations are generated for future modelling applications and data collection. RESULTS AND DISCUSSION We reviewed 1924 abstracts and included 44 studies spanning 2007 to 2017. Modelling has reported that PrEP can be a cost-effective addition to HIV prevention portfolios for some use cases, but also that it would not be cost-effective to fund PrEP before other prevention interventions are expanded. However, our assessment of the quality of the modelling indicates cost-effectiveness analyses failed to comply with standards of reporting for economic evaluations and the assessment of relevance highlighted that both key parameters and scenarios are now outdated. Current evidence gaps include modelling to inform service development using updated programmatic information and ex post modelling to evaluate and inform efficient deployment of resources in support of PrEP, especially among key populations, using direct evidence of cost, adherence and uptake patterns. CONCLUSIONS Updated modelling which more appropriately captures PrEP programme delivery, uses current intervention scenarios, and is parameterized with data from demonstration and implementation projects is needed in support of more conclusive findings and actionable recommendations for programmes and policy. Future analyses should address these issues, aligning with countries to support the needs of programme planners and decision makers for models to more directly inform programme planning and policy.
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Affiliation(s)
- Kelsey K Case
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | - Gabriela B Gomez
- Department of Global Health and DevelopmentLondon School of Hygiene and Tropical MedicineLondonUK
| | - Timothy B Hallett
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
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17
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Pyra MN, Haberer JE, Hasen N, Reed J, Mugo NR, Baeten JM. Global implementation of PrEP for HIV prevention: setting expectations for impact. J Int AIDS Soc 2019; 22:e25370. [PMID: 31456348 PMCID: PMC6712462 DOI: 10.1002/jia2.25370] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Questions remain whether HIV pre-exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population-level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic. DISCUSSION Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event-driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high-risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial. CONCLUSIONS While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.
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Affiliation(s)
- Maria N Pyra
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Jessica E Haberer
- Massachusetts General Hospital Global HealthBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | | | | | - Nelly R Mugo
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Kenya Medical Research Institute (KEMRI)NairobiKenya
| | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
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18
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Glaubius R, Ding Y, Penrose KJ, Hood G, Engquist E, Mellors JW, Parikh UM, Abbas UL. Dapivirine vaginal ring for HIV prevention: modelling health outcomes, drug resistance and cost-effectiveness. J Int AIDS Soc 2019; 22:e25282. [PMID: 31074936 PMCID: PMC6510112 DOI: 10.1002/jia2.25282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/05/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A vaginal ring containing dapivirine is effective for HIV prevention as pre-exposure prophylaxis (PrEP). We evaluated the potential epidemiological impact and cost-effectiveness of dapivirine vaginal ring PrEP among 22- to 45-year-old women in KwaZulu-Natal, South Africa. METHODS Using mathematical modelling, we studied dapivirine vaginal ring PrEP implementation, either unprioritized, or prioritized based on HIV incidence (≥3% per year), age (22 to 29 years) or female sex worker status, alongside the implementation of voluntary medical male circumcision and antiretroviral therapy scaled-up to UNAIDS Fast-Track targets. Outcomes over the intervention (2019 to 2030) and lifetime horizons included cumulative HIV infections, life-years lived, costs and cost-effectiveness. We assessed the incremental cost-effectiveness ratios against the revealed willingness to pay ($500) and the standard (2017 per capita gross domestic product; $6161) cost-effectiveness thresholds for South Africa. RESULTS Compared to a reference scenario without PrEP, implementation of dapivirine vaginal ring PrEP, assuming 56% effectiveness and covering 50% of 22 to 29-year-old or high-incidence women, prevented 10% or 11% of infections by 2030 respectively. Equivalent, unprioritized coverage (30%) prevented fewer infections (7%), whereas 50% coverage of female sex workers had the least impact (4%). Drug resistance attributable to PrEP was modest (2% to 4% of people living with drug-resistant HIV). Over the lifetime horizon, dapivirine PrEP implementation among female sex workers was cost-saving, whereas incidence-based PrEP cost $1898 per life-year gained, relative to PrEP among female sex workers and $989 versus the reference scenario. In a scenario of 37% PrEP effectiveness, PrEP had less impact, but prioritization to female sex workers remained cost-saving. In uncertainty analysis, female sex worker PrEP was consistently cost-saving; and over the lifetime horizon, PrEP cost less than $6161 per life-year gained in over 99% of simulations, whereas incidence- and age-based PrEP cost below $500 per life-year gained in 61% and 49% of simulations respectively. PrEP adherence and efficacy, and the effectiveness of antiretroviral therapy for HIV prevention, were the principal drivers of uncertainty in the cost-effectiveness of PrEP. CONCLUSIONS Dapivirine vaginal ring PrEP would be cost-saving in KwaZulu-Natal if prioritized to female sex workers. PrEP's impact on HIV prevention would be increased, with potential affordability, if prioritized to women by age or incidence.
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Affiliation(s)
- Robert Glaubius
- Departments of Quantitative Health Sciences and Infectious DiseaseCleveland ClinicClevelandOHUSA
| | - Yajun Ding
- Department of MedicineSection of Infectious Diseases and Department of Molecular Virology and MicrobiologyBaylor College of MedicineHoustonTXUSA
| | - Kerri J Penrose
- Division of Infectious DiseasesSchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Greg Hood
- Pittsburgh Supercomputing CenterCarnegie Mellon UniversityPittsburghPAUSA
| | - Erik Engquist
- Center for Research ComputingRice UniversityHoustonTXUSA
| | - John W Mellors
- Division of Infectious DiseasesSchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Urvi M Parikh
- Division of Infectious DiseasesSchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Ume L Abbas
- Departments of Quantitative Health Sciences and Infectious DiseaseCleveland ClinicClevelandOHUSA
- Department of MedicineSection of Infectious Diseases and Department of Molecular Virology and MicrobiologyBaylor College of MedicineHoustonTXUSA
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19
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Whiteley L, Mena L, Craker LK, Healy MG, Brown LK. Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game. JMIR Serious Games 2019; 7:e11861. [PMID: 30916652 PMCID: PMC6456850 DOI: 10.2196/11861] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP’s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. Objective This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. Methods Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. Results A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors’ visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. Conclusions We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM.
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Leandro Mena
- University of Mississippi Medical Center, University of Mississippi, Jackson, MS, United States
| | - Lacey K Craker
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Garver Healy
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Larry K Brown
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
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20
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Shen M, Xiao Y, Rong L, Meyers LA, Bellan SE. The cost-effectiveness of oral HIV pre-exposure prophylaxis and early antiretroviral therapy in the presence of drug resistance among men who have sex with men in San Francisco. BMC Med 2018; 16:58. [PMID: 29688862 PMCID: PMC5914040 DOI: 10.1186/s12916-018-1047-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/28/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Poor adherence to either antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) can promote drug resistance, though this risk is thought to be considerably higher for ART. In the population of men who have sex with men (MSM) in San Francisco, PrEP coverage reached 9.6% in 2014 and has continued to rise. Given the risk of drug resistance and high cost of second-line drugs, the costs and benefits of initiating ART earlier while expanding PrEP coverage remain unclear. METHODS We develop an infection-age-structured mathematical model and fit this model to the annual incidence of AIDS cases and deaths directly, and to resistance and demographic data indirectly. We investigate the impact of six various intervention scenarios (low, medium, or high PrEP coverage, with or without earlier ART) over the next 20 years. RESULTS Low (medium, high) PrEP coverage with earlier ART could prevent 22% (42%, 57%) of a projected 44,508 total new infections and 8% (26%, 41%) of a projected 18,426 new drug-resistant infections, and result in a gain of 43,649 (74,048, 103,270) QALYs over 20 years compared to the status quo, at a cost of $4745 ($78,811, $115,320) per QALY gained, respectively. CONCLUSIONS High PrEP coverage with earlier ART is expected to provide the greatest benefit but also entail the highest costs among the strategies considered. This strategy is cost-effective for the San Francisco MSM population, even considering the acquisition and transmission of ART-mediated drug resistance. However, without a substantial increase to San Francisco's annual HIV budget, the most advisable strategy may be initiating ART earlier, while maintaining current strategies of PrEP enrollment.
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Affiliation(s)
- Mingwang Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China.,School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.,Department of Integrative Biology, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| | - Libin Rong
- Department of Mathematics, University of Florida, Gainesville, FL, 32611, USA
| | - Lauren Ancel Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, 78712, USA.,The Santa Fe Institute, Santa Fe, NM, 87501, USA
| | - Steven E Bellan
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, 30602, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, 30602, USA
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21
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J. Silva C, F. M. Torres D. Modeling and optimal control of HIV/AIDS prevention through PrEP. ACTA ACUST UNITED AC 2018. [DOI: 10.3934/dcdss.2018008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Dunn J, Zhang Q, Weeks MR, Li J, Liao S, Li F. Indigenous HIV Prevention Beliefs and Practices Among Low-Earning Chinese Sex Workers as Context for Introducing Female Condoms and Other Novel Prevention Options. QUALITATIVE HEALTH RESEARCH 2017; 27:1302-1315. [PMID: 27811288 PMCID: PMC5440208 DOI: 10.1177/1049732316673980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
New interventions to reduce HIV and sexually transmitted infections (STI) among female sex workers are introduced into the context of women's existing prevention beliefs and practices. These indigenous practices affected implementation of our program to introduce female condoms to women in sex-work establishments in southern China. We used ethnographic field observations and in-depth interviews to document common prevention methods women reported using to protect themselves before and during intervention implementation. Individual, sex-work establishment, and other contextual factors, including sources of information and social and economic pressures to use or reject prevention options, shaped their perceptions and selection of these methods and affected adoption of female condoms as an additional tool. Efforts to improve uptake of effective prevention methods among low-income sex workers require attention to the context and spectrum of women's HIV/STI prevention practices when introducing innovations such as female condoms, microbicides, pre-exposure prophylaxis pills, and others, as they become available.
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Affiliation(s)
- Jennifer Dunn
- 1 Institute for Community Research, Hartford, Connecticut, USA
| | | | | | - Jianghong Li
- 1 Institute for Community Research, Hartford, Connecticut, USA
| | - Susu Liao
- 3 Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Li
- 3 Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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The Impact of Preexposure Prophylaxis Among Men Who Have Sex With Men: An Individual-Based Model. J Acquir Immune Defic Syndr 2017; 75:175-183. [PMID: 28498144 DOI: 10.1097/qai.0000000000001354] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Preexposure prophylaxis (PrEP) is recommended for preventing HIV infection among individuals at high risk, including men who have sex with men (MSM). Although its individual-level efficacy is proven, questions remain regarding population-level impact of PrEP implementation. DESIGN We developed an agent-based simulation of HIV transmission among MSM, accounting for demographics, sexual contact network, HIV disease stage, and use of antiretroviral therapy. We use this framework to compare PrEP delivery strategies in terms of impact on HIV incidence and prevalence. RESULTS The projected reduction in HIV incidence achievable with PrEP reflects both population-level coverage and individual-level adherence (as a proportion of days protected against HIV transmission). For example, provision of PrEP to 40% of HIV-negative MSM reporting more than one sexual partner in the last 12 months, taken with sufficient adherence to provide protection on 40% of days, can reduce HIV incidence by 9.5% (95% uncertainty range: 8%-11%) within 5 years. However, if this could be increased to 80% coverage on 80% of days (eg, through mass campaigns with a long-acting injectable formulation), a 43% (42%-44%) reduction in HIV incidence could be achieved. Delivering PrEP to MSM at high risk for HIV acquisition can augment population-level impact up to 1.8-fold. CONCLUSIONS If highly ambitious targets for coverage and adherence can be achieved, PrEP can substantially reduce HIV incidence in the short-term. Although the reduction in HIV incidence largely reflects the proportion of person-years protected, the efficiency of PrEP delivery can be enhanced by targeting high-risk populations.
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Healthcare Access and PrEP Continuation in San Francisco and Miami After the US PrEP Demo Project. J Acquir Immune Defic Syndr 2017; 74:531-538. [PMID: 27861236 DOI: 10.1097/qai.0000000000001236] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for prevention of HIV infection has demonstrated efficacy in randomized controlled trials and in demonstration projects. For PrEP implementation to result in significant reductions in HIV incidence for men who have sex with men in the United States, sufficient access to PrEP care and continued engagement outside of demonstration projects is required. METHODS We report the results of a follow-up survey of 173 former participants from the Miami and San Francisco sites of the US PrEP Demo Project, administered 4-6 months after study completion. RESULTS Survey respondents continued to frequently access medical care and had a high incidence of sexually transmitted infections after completion of the Demo Project, indicating ongoing sexual risk behavior. Interest in continuing PrEP was high with 70.8% indicating that they were "very interested" in continuing PrEP. Among respondents, 39.9% reported continuation of PrEP after completion of the Demo Project, largely through their primary care providers and frequently at low or no cost. Variability in access and engagement was seen, with participants from the San Francisco site, those with medical insurance, and those with a primary care provider at the end of the Demo Project more likely to successfully obtain PrEP medication. Two respondents reported HIV seroconversion in the period between study completion and the follow-up survey. CONCLUSIONS Additional effort to increase equitable access to PrEP outside of demonstration projects is needed to realize the potential impact of this evidence-based prevention intervention.
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Awareness and Acceptability of Pre-exposure HIV Prophylaxis Among Men Who have Sex with Men in Baltimore. AIDS Behav 2017; 21:1268-1277. [PMID: 27873081 DOI: 10.1007/s10461-016-1619-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This paper assessed characteristics associated with awareness of and willingness to take pre-exposure prophylaxis (PrEP) among Baltimore men who have sex with men (MSM). We used data from BESURE-MSM3, a venue-based cross-sectional HIV surveillance study conducted among MSM in 2011. Multivariate regression was used to identify characteristics associated with PrEP knowledge and acceptability among 399 participants. Eleven percent had heard of PrEP, 48% would be willing to use PrEP, and none had previously used it. In multivariable analysis, black race and perceived discrimination against those with HIV were significantly associated with decreased awareness, and those who perceived higher HIV discrimination reported higher acceptability of PrEP. Our findings indicate a need for further education about the potential utility of PrEP in addition to other prevention methods among MSM. HIV prevention efforts should address the link between discrimination and potential PrEP use, especially among men of color.
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Safier LZ, Sauer MV. Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care, regardless of their fertility status. J Int AIDS Soc 2017; 20:21294. [PMID: 28361501 PMCID: PMC5577707 DOI: 10.7448/ias.20.2.21294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION With increasing life expectancy, couples with at least one partner afflicted with HIV are more commonly pursuing the opportunity to have biologic offspring. Currently, there are no universally accepted recommendations regarding first line reproductive treatments for HIV serodiscordant couples lacking a history of infertility. We strongly believe that fertility care intervention should be the first line treatment, when affordably accessible, over natural conception for HIV serodiscordant couples to achieve pregnancy in a safe and efficacious manner. Discussion In the era of highly active anti-retroviral therapy, in combination with timed intercourse and pre-exposure prophylaxis for the HIV negative partner, some members of the medical community are arguing in favour of natural conception as a means of achieving pregnancy in this patient population. In our opinion, laboratory assisted fertility methods, including intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection with semen washing should be the first line treatment recommendation for HIV serodiscordant couples desiring pregnancy for the following reasons: (1) abundance of evidence in the medical literature supporting the safety profile and efficacy of fertility care intervention in couples with HIV; paucity of data addressing safety of natural conception in comparison to fertility intervention techniques (2) unknown public health impact of promoting natural conception as a safe means of achieving pregnancy (3) ethical implications: patients should be offered the available and accessible treatment option posing the lowest possible known risk to the uninfected partner. Conclusions We believe that physician assisted fertility care, when affordably accessible, should be the treatment of choice over natural conception. While the preliminary data on natural conception in couples using highly active anti-retroviral therapy/pre-exposure prophylaxis/timed intercourse appears promising, we believe that this approach should be limited to patients in resource poor settings where more sophisticated measures do not exist or for patients that simply cannot afford subspecialty care. There are likely to be unknown psychological and behavioural factors impacted by promoting natural conception and diminishing the importance of safe sex practices. Additionally, it is our moral obligation to patients to offer the affordably accessible treatment interventions that pose the least known risk when considering reproductive options.
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Affiliation(s)
- Lauren Zakarin Safier
- Department of Obstetrics and Gynecology, New York Presbyterian-Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Mark V Sauer
- Department of Obstetrics and Gynecology, New York Presbyterian-Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Zhao Y, Wood DT, Kojouharov HV, Kuang Y, Dimitrov DT. Impact of Population Recruitment on the HIV Epidemics and the Effectiveness of HIV Prevention Interventions. Bull Math Biol 2016; 78:2057-2090. [PMID: 27704329 DOI: 10.1007/s11538-016-0211-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
Mechanistic mathematical models are increasingly used to evaluate the effectiveness of different interventions for HIV prevention and to inform public health decisions. By focusing exclusively on the impact of the interventions, the importance of the demographic processes in these studies is often underestimated. In this paper, we use simple deterministic models to assess the effectiveness of pre-exposure prophylaxis in reducing the HIV transmission and to explore the influence of the recruitment mechanisms on the epidemic and effectiveness projections. We employ three commonly used formulas that correspond to constant, proportional and logistic recruitment and compare the dynamical properties of the resulting models. Our analysis exposes substantial differences in the transient and asymptotic behavior of the models which result in 47 % variation in population size and more than 6 percentage points variation in HIV prevalence over 40 years between models using different recruitment mechanisms. We outline the strong influence of recruitment assumptions on the impact of HIV prevention interventions and conclude that detailed demographic data should be used to inform the integration of recruitment processes in the models before HIV prevention is considered.
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Affiliation(s)
- Yuqin Zhao
- School of Mathematics, University of Minnesota, Minneapolis, MN, USA
| | - Daniel T Wood
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hristo V Kojouharov
- Department of Mathematics, The University of Texas at Arlington, Arlington, TX, USA
| | - Yang Kuang
- Department of Mathematics and Statistics, Arizona State University, Tempe, AZ, USA
| | - Dobromir T Dimitrov
- Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Dimitrov DT, Boily MC, Hallett TB, Albert J, Boucher C, Mellors JW, Pillay D, van de Vijver DAMC. How Much Do We Know about Drug Resistance Due to PrEP Use? Analysis of Experts' Opinion and Its Influence on the Projected Public Health Impact. PLoS One 2016; 11:e0158620. [PMID: 27391094 PMCID: PMC4938235 DOI: 10.1371/journal.pone.0158620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Randomized controlled trials reported that pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine rarely selects for drug resistance. However, drug resistance due to PrEP is not completely understood. In daily practice, PrEP will not be used under the well-controlled conditions available in the trials, suggesting that widespread use of PrEP can result in increased drug resistance. METHODS We surveyed expert virologists with questions about biological assumptions regarding drug resistance due to PrEP use. The influence of these assumptions on the prevalence of drug resistance and the fraction of HIV transmitted resistance was studied with a mathematical model. For comparability, 50% PrEP-coverage of and 90% per-act efficacy of PrEP in preventing HIV acquisition are assumed in all simulations. RESULTS Virologists disagreed on the following: the time until resistance emergence (range: 20-180 days) in infected PrEP users with breakthrough HIV infections; the efficacy of PrEP against drug-resistant HIV (25%-90%); and the likelihood of resistance acquisition upon transmission (10%-75%). These differences translate into projections of 0.6%- 1% and 3.5%-6% infected individuals with detectable resistance 10 years after introducing PrEP, assuming 100% and 50% adherence, respectively. The rate of resistance emergence following breakthrough HIV infection and the rate of resistance reversion after PrEP use is discontinued, were the factors identified as most influential on the expected resistance associated with PrEP. Importantly, 17-23% infected individuals could virologically fail treatment as a result of past PrEP use or transmitted resistance to PrEP with moderate adherence. CONCLUSIONS There is no broad consensus on quantification of key biological processes that underpin the emergence of PrEP-associated drug resistance. Despite this, the contribution of PrEP use to the prevalence of the detectable drug resistance is expected to be small. However, individuals who become infected despite the use of PrEP should be closely monitored due to higher risk of virological failure when initiating antiretroviral treatment in the future.
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Affiliation(s)
- Dobromir T. Dimitrov
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Applied Mathematics, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Timothy B. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Charles Boucher
- Department of Virology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - John W. Mellors
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Deenan Pillay
- Research Department of Infection, University College Medical School, London, United Kingdom
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Glaubius RL, Parikh UM, Hood G, Penrose KJ, Bendavid E, Mellors JW, Abbas UL. Deciphering the Effects of Injectable Pre-exposure Prophylaxis for Combination Human Immunodeficiency Virus Prevention. Open Forum Infect Dis 2016; 3:ofw125. [PMID: 27703992 PMCID: PMC5047428 DOI: 10.1093/ofid/ofw125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/14/2016] [Indexed: 11/26/2022] Open
Abstract
Injectable antiretrovirals including non-nucleoside reverse transcriptase inhibitors are being evaluated for pre-exposure prophylaxis for HIV prevention. Mathematical modeling suggests that injectable pre-exposure prophylaxis among KwaZulu-Natal's at-risk populations could have substantial preventive impact but may increase drug resistance unless highly effective. Background. A long-acting injectable formulation of rilpivirine (RPV), under investigation as antiretroviral pre-exposure prophylaxis (PrEP), may facilitate PrEP adherence. In contrast, cross-resistance between RPV and nonnucleoside reverse-transcriptase inhibitors comprising first-line antiretroviral therapy (ART) could promote human immunodeficiency virus (HIV) drug resistance and reduce PrEP's effectiveness. Methods. We use novel mathematical modeling of different RPV PrEP scale-up strategies in KwaZulu-Natal, South Africa, to investigate their effects on HIV prevention and drug resistance, compared with a reference scenario without PrEP. Results. Pre-exposure prophylaxis scale-up modestly increases the proportion of prevalent drug-resistant infections, from 33% to ≤37%. The change in the number of prevalent drug-resistant infections depends on the interplay between PrEP factors (coverage, efficacy, delivery reliability, and scale-up strategy) and the level of cross-resistance between PrEP and ART. An optimistic scenario of 70% effective RPV PrEP (90% efficacious and 80% reliable delivery), among women aged 20–29 years, prevents 17% of cumulative infections over 10 years while decreasing prevalent resistance; however, prevention decreases and resistance increases with more conservative assumptions. Uncertainty analysis assuming 40%–70% cross-resistance prevalence predicts an increase in prevalent resistance unless PrEP's effectiveness exceeds 90%. Conclusions. Prioritized scale-up of injectable PrEP among women in KwaZulu-Natal could reduce HIV infections, but suboptimal effectiveness could promote the spread of drug resistance.
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Affiliation(s)
- Robert L Glaubius
- Departments of Infectious Disease and Quantitative Health Sciences , Cleveland Clinic , Ohio
| | - Urvi M Parikh
- Division of Infectious Diseases , School of Medicine, University of Pittsburgh
| | - Greg Hood
- Pittsburgh Supercomputing Center , Carnegie Mellon University , Pennsylvania
| | - Kerri J Penrose
- Division of Infectious Diseases , School of Medicine, University of Pittsburgh
| | - Eran Bendavid
- Division of Infectious Diseases, Department of Medicine , Stanford University , California
| | - John W Mellors
- Division of Infectious Diseases , School of Medicine, University of Pittsburgh
| | - Ume L Abbas
- Departments of Infectious Disease and Quantitative Health Sciences, Cleveland Clinic, Ohio; Section of Infectious Diseases, Department of Medicine, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
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Glaubius RL, Hood G, Penrose KJ, Parikh UM, Mellors JW, Bendavid E, Abbas UL. Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa. Clin Infect Dis 2016; 63:539-47. [PMID: 27193745 DOI: 10.1093/cid/ciw321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Long-acting injectable antiretrovirals such as rilpivirine (RPV) could promote adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. However, the cost-effectiveness of injectable PrEP is unclear. METHODS We constructed a dynamic model of the heterosexual HIV epidemic in KwaZulu-Natal, South Africa, and analyzed scenarios of RPV PrEP scale-up for combination HIV prevention in comparison with a reference scenario without PrEP. We estimated new HIV infections, life-years and costs, and incremental cost-effectiveness ratios (ICERs), over 10-year and lifetime horizons, assuming a societal perspective. RESULTS Compared with no PrEP, unprioritized scale-up of RVP PrEP covering 2.5%-15% of adults prevented up to 9% of new infections over 10 years. HIV prevention doubled (17%) when the same coverage was prioritized to 20- to 29-year-old women, costing $10 880-$19 213 per infection prevented. Prioritization of PrEP to 80% of individuals at highest behavioral risk achieved comparable prevention (4%-8%) at <1% overall coverage, costing $298-$1242 per infection prevented. Over lifetime, PrEP scale-up among 20- to 29-year-old women was very cost-effective (<$1600 per life-year gained), dominating unprioritized PrEP, while risk prioritization was cost-saving. PrEP's 10-year impact decreased by almost 50% with increases in ICERs (up to 4.2-fold) in conservative base-case analysis. Sensitivity analysis identified PrEP's costs, efficacy, and reliability of delivery as the principal drivers of uncertainty in PrEP's cost-effectiveness, and PrEP remained cost-effective under the assumption of universal access to second-line antiretroviral therapy. CONCLUSIONS Compared with no PrEP, prioritized scale-up of RPV PrEP in KwaZulu-Natal could be very cost-effective or cost-saving, but suboptimal PrEP would erode benefits and increase costs.
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Affiliation(s)
- Robert L Glaubius
- Departments of Infectious Disease and Quantitative Health Sciences, Cleveland Clinic, Ohio
| | - Greg Hood
- Pittsburgh Supercomputing Center, Carnegie Mellon University
| | - Kerri J Penrose
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Urvi M Parikh
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pennsylvania
| | - John W Mellors
- Division of Infectious Diseases, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Eran Bendavid
- Division of Infectious Diseases, Department of Medicine, Stanford University, California
| | - Ume L Abbas
- Departments of Infectious Disease and Quantitative Health Sciences, Cleveland Clinic, Ohio Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
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Blaizot S, Maman D, Riche B, Mukui I, Kirubi B, Ecochard R, Etard JF. Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya: a modelling study. BMC Infect Dis 2016; 16:189. [PMID: 27129591 PMCID: PMC4851795 DOI: 10.1186/s12879-016-1520-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 04/18/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya). METHODS A mathematical model was used with data on adults (15-59 years) from the Ndhiwa HIV Impact in Population Survey to compare the impacts on HIV prevalence, HIV incidence rate, and population viral load suppression of various interventions. These interventions included: improving the cascade of care (use of three guidelines), increasing voluntary medical male circumcision (VMMC), and implementing pre-exposure prophylaxis (PrEP) use among HIV-uninfected women. RESULTS After four years, improving separately the cascade of care under the WHO 2013 guidelines and under the treat-all strategy would reduce the overall HIV incidence rate by 46 and 58 %, respectively, vs. the baseline rate, and by 35 and 49 %, respectively, vs. the implementation of the current Kenyan guidelines. With conservative and optimistic scenarios, VMMC and PrEP would reduce the HIV incidence rate by 15-25 % and 22-28 % vs. the baseline, respectively. Combining the WHO 2013 guidelines with VMMC would reduce the HIV incidence rate by 35-56 % and combining the treat-all strategy with VMMC would reduce it by 49-65 %. Combining the WHO 2013 guidelines, VMMC, and PrEP would reduce the HIV incidence rate by 46-67 %. CONCLUSIONS The impacts of the WHO 2013 guidelines and the treat-all strategy were relatively close; their implementation is desirable to reduce HIV spread. Combining several strategies is promising in adult populations of hyperendemic areas but requires regular, reliable, and costly monitoring.
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Affiliation(s)
- Stéphanie Blaizot
- Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France. .,Université de Lyon, F-69000, Lyon, France. .,Université Lyon 1, F-69100, Villeurbanne, France. .,CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100, Villeurbanne, France.
| | | | - Benjamin Riche
- Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France.,Université de Lyon, F-69000, Lyon, France.,Université Lyon 1, F-69100, Villeurbanne, France.,CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100, Villeurbanne, France
| | - Irene Mukui
- National AIDS and STDs Control Program, Nairobi, Kenya
| | | | - René Ecochard
- Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France.,Université de Lyon, F-69000, Lyon, France.,Université Lyon 1, F-69100, Villeurbanne, France.,CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100, Villeurbanne, France
| | - Jean-François Etard
- Epicentre, F-75011, Paris, France.,UMI 233 TransVIHMI, Institut de Recherche pour le Développement, Université Montpellier 1, F-34000, Montpellier, France
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Brooks RA, Landovitz RJ, Regan R, Lee SJ, Allen VC. Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS 2015; 26:1040-8. [PMID: 25638214 PMCID: PMC4520772 DOI: 10.1177/0956462415570159] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/03/2015] [Indexed: 11/17/2022]
Abstract
This study assessed perceptions of pre-exposure prophylaxis (PrEP) and their association with PrEP adoption intention among a convenience sample of 224 low socioeconomic status black men who have sex with men (BMSM) residing in Los Angeles. Participants received educational information about PrEP and completed an in-person interview. More than half (60%) of the participants indicated a high intention to adopt PrEP. Younger BMSM (18-29 years) were twice as likely to report a high intention to adopt PrEP compared to older BMSM (30+ years). Only 33% of participants were aware of PrEP and no participant had ever used PrEP. Negative perceptions were associated with a lower PrEP adoption intention and included being uncomfortable taking an HIV medicine when HIV-negative and not knowing if there are long-term side effects of taking an HIV medication. These findings suggest that BMSM may adopt PrEP but that negative perceptions may limit its uptake among this population. In order to facilitate PrEP adoption among BMSM targeted educational and community awareness programmes are needed to provide accurate information on the benefits of PrEP and to address the negative perceptions of PrEP held by local BMSM populations.
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Affiliation(s)
- Ronald A Brooks
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Raphael J Landovitz
- Division of Infectious Diseases, Center for Clinical AIDS Research & Education, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Rotrease Regan
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sung-Jae Lee
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vincent C Allen
- Department of Psychology, University of California, Los Angeles, CA, USA
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Hankins C, Macklin R, Warren M. Translating PrEP effectiveness into public health impact: key considerations for decision-makers on cost-effectiveness, price, regulatory issues, distributive justice and advocacy for access. J Int AIDS Soc 2015; 18:19973. [PMID: 26198343 PMCID: PMC4509900 DOI: 10.7448/ias.18.4.19973] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The extraordinary feat of proving the effectiveness of oral pre-exposure prophylaxis (PrEP) in clinical trials in different populations in a variety of settings may prove to have been easier than ensuring it is used well. Decision-makers must make difficult choices to realize the promise of antiretroviral prophylaxis for their countries. This paper outlines key economic, regulatory and distributive justice issues that must be addressed for effective and acceptable PrEP implementation. DISCUSSION In considering the role that PrEP can play in combination prevention programmes, decision-makers must determine who can benefit most from PrEP, how PrEP can be provided safely and efficiently, and what kind of health system support will ensure successful implementation. To do this, they need contextualized information on disease burden by population, analyses of how PrEP services might best be delivered, and projections of the human resource and infrastructure requirements for each potential delivery model. There are cost considerations, varying cost-effectiveness results and regulatory challenges. The principles of ethics can inform thorny discussions about who should be prioritized for oral PrEP and how best to introduce it fairly. We describe the cost-effectiveness of PrEP in different populations at higher risk of HIV exposure, its price in low- and middle-income countries, and the current regulatory situation. We explore the principles of ethics that can inform resource allocation decision-making about PrEP anchored in distributive justice, at a time when universal access to antiretroviral treatment remains to be assured. We then highlight the role of advocacy in moving the PrEP agenda forward. CONCLUSIONS The time is ripe now for decisions about whether, how and for whom PrEP should be introduced into a country's HIV response. It has the potential to contribute significantly to high impact HIV prevention if it is tailored to those who can most benefit from it and if current regulatory and pricing barriers can be overcome. Advocacy at all levels can help inform decision-making and push the access agenda to avert HIV infections among those at highest risk of HIV exposure. The benefits will accrue beyond the individual level to slow HIV transmission at the population level.
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Affiliation(s)
- Catherine Hankins
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England; ;
| | - Ruth Macklin
- Epidemiology & Population Health, Albert Einstein College of Medicine New York, NY, USA
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Cáceres CF, Mayer KH, Baggaley R, O'Reilly KR. PrEP Implementation Science: State-of-the-Art and Research Agenda. J Int AIDS Soc 2015; 18:20527. [PMID: 26198351 PMCID: PMC4581083 DOI: 10.7448/ias.18.4.20527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Palanee-Phillips T, Schwartz K, Brown ER, Govender V, Mgodi N, Kiweewa FM, Nair G, Mhlanga F, Siva S, Bekker LG, Jeenarain N, Gaffoor Z, Martinson F, Makanani B, Naidoo S, Pather A, Phillip J, Husnik MJ, van der Straten A, Soto-Torres L, Baeten J. Characteristics of Women Enrolled into a Randomized Clinical Trial of Dapivirine Vaginal Ring for HIV-1 Prevention. PLoS One 2015; 10:e0128857. [PMID: 26061040 PMCID: PMC4489588 DOI: 10.1371/journal.pone.0128857] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/01/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Women in sub-Saharan Africa are a priority population for evaluation of new biomedical HIV-1 prevention strategies. Antiretroviral pre-exposure prophylaxis is a promising prevention approach; however, clinical trials among young women using daily or coitally-dependent products have found low adherence. Antiretroviral-containing vaginal microbicide rings, which release medication over a month or longer, may reduce these adherence challenges. Methods ASPIRE (A Study to Prevent Infection with a Ring for Extended Use) is a phase III, randomized, double-blind, placebo-controlled trial testing the safety and effectiveness of a vaginal ring containing the non-nucleoside reverse transcriptase inhibitor dapivirine for prevention of HIV-1 infection. We describe the baseline characteristics of African women enrolled in the ASPIRE trial. Results Between August 2012 and June 2014, 5516 women were screened and 2629 HIV-1 seronegative women between 18–45 years of age were enrolled from 15 research sites in Malawi, South Africa, Uganda, and Zimbabwe. The median age was 26 years (IQR 22–31) and the majority (59%) were unmarried. Nearly 100% of participants reported having a primary sex partner in the prior three months but 43% did not know the HIV-1 status of their primary partner; 17% reported additional concurrent partners. Nearly two-thirds (64%) reported having disclosed to primary partners about planned vaginal ring use in the trial. Sexually transmitted infections were prevalent: 12% had Chlamydia trachomatis, 7% Trichomonas vaginalis, 4% Neisseria gonorrhoeae, and 1% syphilis. Conclusions African HIV-1 seronegative women at risk of HIV -1 infection were successfully enrolled into a phase III trial of dapivirine vaginal ring for HIV-1 prevention.
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Affiliation(s)
- Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Research Institute, University of the Witswatersrand, School of Clinical Medicine, Johannesburg, South Africa
| | | | - Elizabeth R. Brown
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Vaneshree Govender
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nyaradzo Mgodi
- University of Zimbabwe—University of California San Francisco Collaborative Research Program (UZ-UCSF) Research Collaboration, Harare, Zimbabwe
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gonasagrie Nair
- Centre for AIDS Programme of Research in SA (CAPRISA), Durban, South Africa
| | - Felix Mhlanga
- University of Zimbabwe—University of California San Francisco Collaborative Research Program (UZ-UCSF) Research Collaboration, Harare, Zimbabwe
| | - Samantha Siva
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation Clinical Research Site, Cape Town, South Africa
| | - Nitesha Jeenarain
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Zakir Gaffoor
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | | | - Bonus Makanani
- College of Medicine-John Hopkins University Research Project Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Sarita Naidoo
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Arendevi Pather
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Jessica Phillip
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Marla J. Husnik
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | | | - Lydia Soto-Torres
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Mental Health, and Eunice Shriver Kennedy, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States of America
| | - Jared Baeten
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, United States of America
- * E-mail:
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Corneli A, Field S, Namey E, Agot K, Ahmed K, Odhiambo J, Skhosana J, Guest G. Preparing for the Rollout of Pre-Exposure Prophylaxis (PrEP): A Vignette Survey to Identify Intended Sexual Behaviors among Women in Kenya and South Africa if Using PrEP. PLoS One 2015; 10:e0129177. [PMID: 26056842 PMCID: PMC4461172 DOI: 10.1371/journal.pone.0129177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/05/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Several clinical trials have demonstrated the efficacy of pre-exposure prophylaxis (PrEP) in reducing HIV risk. One concern with introducing PrEP is whether users will engage in riskier sexual behaviors. METHODS We assessed the effect that PrEP may have on sexual risk behaviors by administering a survey to 799 women in Bondo, Kenya, and Pretoria, South Africa. Participants were asked about their sexual behavior intentions twice--once as if they were taking PrEP and once as if they were not taking PrEP--within four risk situations (vignettes). They responded using a 5-point ordinal scale. We used a series of linear mixed effects models with an unstructured residual covariance matrix to estimate the between- and within-subject differences in the mean likelihood of engaging in risky sexual behavior across the PrEP and non-PrEP contexts. We also calculated the total percentage of participants who reported a greater likelihood of engaging in risky sexual behavior if taking PrEP than if not taking PrEP, by vignette. RESULTS We found statistically significant differences in the mean likelihood of engaging in risky sexual behavior with the between-subject comparison (-0.17, p < 0.01) and with the within-subject comparison (-0.31, p < 0.001). Depending on the vignette, 27% to 40% of participants reported a greater likelihood of engaging in risky sexual behavior if taking PrEP than if not taking PrEP. CONCLUSIONS Our findings indicate that modest increases in risky sexual behavior could occur with PrEP. Although responses from the majority of participants suggest they would not be more likely to engage in risky sexual behavior if they took PrEP, a substantial proportion might. Programs rolling out PrEP should be prepared to assist similar women in making informed choices about reducing their risk of HIV and about their sexual health beyond HIV prevention.
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Affiliation(s)
- Amy Corneli
- Social and Behavioral Health Sciences, FHI 360, Durham, NC, United States of America
| | - Samuel Field
- Biostatistics, FHI 360, Durham, NC, United States of America
| | - Emily Namey
- Social and Behavioral Health Sciences, FHI 360, Durham, NC, United States of America
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Jacob Odhiambo
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Greg Guest
- Social and Behavioral Health Sciences, FHI 360, Durham, NC, United States of America
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Carnegie NB, Goodreau SM, Liu A, Vittinghoff E, Sanchez J, Lama JR, Buchbinder S. Targeting pre-exposure prophylaxis among men who have sex with men in the United States and Peru: partnership types, contact rates, and sexual role. J Acquir Immune Defic Syndr 2015; 69:119-25. [PMID: 25942463 PMCID: PMC4422184 DOI: 10.1097/qai.0000000000000555] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND We aim to identify optimal strategies for deploying pre-exposure prophylaxis among men who have sex with men (MSM) in the United States and Peru to maximize population-level effectiveness in an efficient manner. We use epidemic models to simulate the impact of targeting strategies. Most studies have focused on targeting either the general population or high-risk MSM. Alternative strategies, including serodiscordant couples, may better balance effectiveness and efficiency. METHODS We use dynamic stochastic sexual network models based on exponential-family random graph modeling, parameterized from behavioral surveys of MSM in the United States and Peru. These models represent main partnerships and casual contacts separately, permitting modeling of interventions targeting men whose risk derives from combinations of relational types. We also model varying rates of uptake and adherence to pre-exposure prophylaxis (PrEP). We assess sensitivity of results to risk compensation through increases in condomless casual contacts and condomless sex in main partnerships. RESULTS Targeting all men who are not exclusively insertive has the largest impact on HIV incidence, but targeting only those with high levels of casual activity yields comparable results using fewer person-years on PrEP. The effect is robust to risk compensation in the United States, but less so in Peru. Targeting serodiscordant main partnerships does not significantly impact incidence, but requires fewer person-years on PrEP per infection averted than other strategies. CONCLUSIONS PrEP could be effective in reducing new infections at the population level in both settings. Serodiscordant partnerships are an attractive component of a targeting program, but targeting should include other high-risk men.
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Affiliation(s)
| | | | - Albert Liu
- San Francisco Department of Public Health
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Buchbinder SP, Liu AY. CROI 2015: Advances in HIV Testing and Prevention Strategies. TOPICS IN ANTIVIRAL MEDICINE 2015; 23:8-27. [PMID: 25965309 PMCID: PMC6148903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 06/04/2023]
Abstract
HIV testing rates and awareness of HIV serostatus have improved globally, but disparities continue between black and white men who have sex with men (MSM) in the United States, and between women and men globally. The 2015 Conference on Retroviruses and Opportunistic Infections (CROI) was a watershed moment for preexposure prophylaxis (PrEP). Two efficacy trials conducted in MSM were stopped early because of an 86% reduction in the risk of HIV acquisition among men taking tenofovir and emtricitabine. New drugs, long-acting formulations, and different patterns of dosing are undergoing evaluation. Poor adherence has limited PrEP effectiveness in some populations, and new measures of drug levels in dried blood spots and hair appear to be promising new tools. Pharmacokinetic differences of PrEP agents in rectal versus vaginal tissue preclude extrapolating PrEP trial results among MSM to women. Several studies reported no HIV transmissions between HIV-serodiscordant couples when the seropositive partner was successfully treated for 6 months. However, consistent viral suppression does not occur in a substantial minority of patients in many clinics, reducing the potential impact of treatment as prevention.
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Affiliation(s)
- Susan P Buchbinder
- University of California San Francisco and San Francisco Department of Public Health, San Francisco, CA, USA
| | - Albert Y Liu
- University of California San Francisco and San Francisco Department of Public Health, San Francisco, CA, USA
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HIV treatment as prevention: contradictory perspectives from dynamic mathematical models. ScientificWorldJournal 2014; 2014:760734. [PMID: 25580461 PMCID: PMC4279253 DOI: 10.1155/2014/760734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/26/2014] [Indexed: 12/20/2022] Open
Abstract
The preventative effects of antiretroviral therapy for people with HIV have been debated since they were first raised. Models commenced studying the preventive effects of treatment in the 1990s, prior to initial public reports. However, the outcomes of the preventive effects of antiretroviral use were not consistent. Some outcomes of dynamic models were based on unfeasible assumptions, such as no consideration of drug resistance, behavior disinhibition, or economic inputs in poor countries, and unrealistic input variables, for example, overstated initiation time, adherence, coverage, and efficacy of treatment. This paper reviewed dynamic mathematical models to ascertain the complex effects of ART on HIV transmission. This review discusses more conservative inputs and outcomes relative to antiretroviral use in HIV infections in dynamic mathematical models. ART alone cannot eliminate HIV transmission.
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ARV-based HIV prevention for women - where we are in 2014. J Int AIDS Soc 2014; 17:19154. [PMID: 25224614 PMCID: PMC4164013 DOI: 10.7448/ias.17.3.19154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/24/2014] [Accepted: 07/22/2014] [Indexed: 01/19/2023] Open
Abstract
Women continue to be at special risk for HIV acquisition due to a complex mix of biological, behavioural, structural, cultural and social factors, with unacceptable rates of new infection. Scientific advances over the past decade have highlighted the use of antiretroviral (ARV) drugs as pre-exposure prophylaxis (PrEP) to prevent HIV acquisition (sexually, parenterally and vertically) and ARV treatment (ART) for HIV-positive patients to prevent onward transmission (treatment as prevention – TasP). This paper reviews the evidence base for PrEP and TasP, describes new products in development and the need to translate research findings into programmes with impact at the population level.
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McMahon JM, Myers JE, Kurth AE, Cohen SE, Mannheimer SB, Simmons J, Pouget ER, Trabold N, Haberer JE. Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care STDS 2014; 28:462-74. [PMID: 25045996 PMCID: PMC4135325 DOI: 10.1089/apc.2013.0302] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP-injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Ann E. Kurth
- College of Nursing, New York University, New York, New York
| | - Stephanie E. Cohen
- San Francisco Department of Public Health, STD Prevention and Control, San Francisco, California
| | - Sharon B. Mannheimer
- Department of Medicine, Harlem Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Janie Simmons
- National Development and Research Institutes, New York, New York
| | | | - Nicole Trabold
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, Massachusetts
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Yu W, Wang L, Han N, Zhang X, Mahapatra T, Mahapatra S, Babu GR, Tang W, Detels R, Zhao J. Pre-exposure prophylaxis of HIV: A right way to go or a long way to go? ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2014; 44:201-8. [PMID: 25078629 DOI: 10.3109/21691401.2014.934458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP as a cost-effective intervention with adequate coverage.
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Affiliation(s)
- Wenya Yu
- a Shijiazhuang Center for Disease Control and Prevention , Shijia Zhuang , China
| | - Lu Wang
- b National Center for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention , Beijing , China
| | - Na Han
- c Institute of Clinical Molecular Biology, Peking University People's Hospital , Beijing China
| | - Xiayan Zhang
- b National Center for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention , Beijing , China
| | - Tanmay Mahapatra
- d Mission Arogya Health and Information Technology Research Foundation , Kolkata , India
| | - Sanchita Mahapatra
- d Mission Arogya Health and Information Technology Research Foundation , Kolkata , India
| | - Giridhar R Babu
- e Public Health Foundation of India, Indian Institutes of Public Health , Hyderabad, Bengaluru Campus, Bengaluru , India
| | - Weiming Tang
- f University of North Carolina , Project-China, Guangzhou , China
| | - Roger Detels
- g Department of Epidemiology , Fielding School of Public Health, University of California , Los Angeles , CA , USA
| | - Jinkou Zhao
- h Impact Results and Evaluation Department, The Global Fund to Fight AIDS , Tuberculosis and Malaria, Geneva , Switzerland
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Cost-effectiveness of PrEP in HIV/AIDS control in Zambia: a stochastic league approach. J Acquir Immune Defic Syndr 2014; 66:221-8. [PMID: 24694930 DOI: 10.1097/qai.0000000000000145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Earlier antiretroviral therapy initiation and pre-exposure prophylaxis (PrEP) prevent HIV, although at a substantial cost. We use mathematical modeling to compare the cost-effectiveness and economic affordability of antiretroviral-based prevention strategies in rural Macha, Zambia. METHODS We compare the epidemiological impact and cost-effectiveness over 40 years of a baseline scenario (treatment initiation at CD4 <350 cells/μL) with treatment initiation at CD4 <500 cells per microliter, and PrEP (prioritized to the most sexually active, or nonprioritized). A strategy is cost effective when the incremental cost-effectiveness ratio (ICER) is <$3480 (<3 times Zambian per capita GDP). Stochastic league tables then predict the optimal intervention per budget level. RESULTS All scenarios will reduce the prevalence from 6.2% (interquartile range, 5.8%-6.6%) in 2014 to about 1% after 40 years. Compared with the baseline, 16% of infections will be averted with prioritized PrEP plus treatment at CD4 <350, 34% with treatment at CD4 <500, and 59% with nonprioritized PrEP plus treatment at CD4 <500. Only treating at CD4 <500 is cost effective: ICER of $62 ($46-$75). Nonprioritized PrEP plus treating at CD4 <500 is borderline cost effective: ICER of $5861 ($3959-$8483). Initiating treatment at CD4 <500 requires a budget increase from $20 million to $25 million over 40 years, with a 96.7% probability of being the optimal intervention. PrEP should only be considered when the budget exceeds $180 million. CONCLUSIONS Treatment initiation at CD4 <500 is a cost-effective HIV prevention approach that will require a modest increase in budget. Although adding PrEP will avert more infections, it is not economically feasible, as it requires a 10-fold increase in budget.
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Dimitrov D, Kuang Y, Mâsse BR. Assessing the Public Health impact of HIV interventions: the critical role of demographics. J Acquir Immune Defic Syndr 2014; 66:e60-2. [PMID: 24828270 PMCID: PMC4053692 DOI: 10.1097/qai.0000000000000133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dobromir Dimitrov
- *Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA †Department of Applied Mathematics, University of Washington, Seattle, WA ‡School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ §Department of Mathematics, King Abdulaziz University, Jeddah, Saudi Arabia ‖CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
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McCormick AW, Abuelezam NN, Rhode ER, Hou T, Walensky RP, Pei PP, Becker JE, DiLorenzo MA, Losina E, Freedberg KA, Lipsitch M, Seage GR. Development, calibration and performance of an HIV transmission model incorporating natural history and behavioral patterns: application in South Africa. PLoS One 2014; 9:e98272. [PMID: 24867402 PMCID: PMC4035281 DOI: 10.1371/journal.pone.0098272] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/28/2014] [Indexed: 11/19/2022] Open
Abstract
Understanding HIV transmission dynamics is critical to estimating the potential population-wide impact of HIV prevention and treatment interventions. We developed an individual-based simulation model of the heterosexual HIV epidemic in South Africa and linked it to the previously published Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International Model, which simulates the natural history and treatment of HIV. In this new model, the CEPAC Dynamic Model (CDM), the probability of HIV transmission per sexual encounter between short-term, long-term and commercial sex worker partners depends upon the HIV RNA and disease stage of the infected partner, condom use, and the circumcision status of the uninfected male partner. We included behavioral, demographic and biological values in the CDM and calibrated to HIV prevalence in South Africa pre-antiretroviral therapy. Using a multi-step fitting procedure based on Bayesian melding methodology, we performed 264,225 simulations of the HIV epidemic in South Africa and identified 3,750 parameter sets that created an epidemic and had behavioral characteristics representative of a South African population pre-ART. Of these parameter sets, 564 contributed 90% of the likelihood weight to the fit, and closely reproduced the UNAIDS HIV prevalence curve in South Africa from 1990–2002. The calibration was sensitive to changes in the rate of formation of short-duration partnerships and to the partnership acquisition rate among high-risk individuals, both of which impacted concurrency. Runs that closely fit to historical HIV prevalence reflect diverse ranges for individual parameter values and predict a wide range of possible steady-state prevalence in the absence of interventions, illustrating the value of the calibration procedure and utility of the model for evaluating interventions. This model, which includes detailed behavioral patterns and HIV natural history, closely fits HIV prevalence estimates.
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Affiliation(s)
- Alethea W. McCormick
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Nadia N. Abuelezam
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Erin R. Rhode
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Taige Hou
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Rochelle P. Walensky
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America
| | - Pamela P. Pei
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jessica E. Becker
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Madeline A. DiLorenzo
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Elena Losina
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Kenneth A. Freedberg
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Marc Lipsitch
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Center for Communicable Disease Dynamics and Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - George R. Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Kagaayi J, Gray RH, Whalen C, Fu P, Neuhauser D, McGrath JW, Sewankambo NK, Serwadda D, Kigozi G, Nalugoda F, Reynolds SJ, Wawer MJ, Singer ME. Indices to measure risk of HIV acquisition in Rakai, Uganda. PLoS One 2014; 9:e92015. [PMID: 24704778 PMCID: PMC3976261 DOI: 10.1371/journal.pone.0092015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 02/18/2014] [Indexed: 01/29/2023] Open
Abstract
Introduction Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender-specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda. Methods We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike's information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell's concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models. Results We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner's HIV status and community HIV prevalence. The Model's optimism-corrected c index was 69.1 percent (95% CI = 0.66, 0.73). The final women's model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI = 0.64, 0.70). Both models were well calibrated. Conclusion These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.
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Affiliation(s)
- Joseph Kagaayi
- Rakai Health Sciences Program, Entebbe, Uganda
- Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christopher Whalen
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America
| | - Pingfu Fu
- Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Duncan Neuhauser
- Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Janet W. McGrath
- Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | | | - David Serwadda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Godfrey Kigozi
- Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Fred Nalugoda
- Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Steven J. Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Maria J. Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mendel E. Singer
- Deparment of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America
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Donastorg Y, Barrington C, Perez M, Kerrigan D. Abriendo Puertas: baseline findings from an integrated intervention to promote prevention, treatment and care among FSW living with HIV in the Dominican Republic. PLoS One 2014; 9:e88157. [PMID: 24551079 PMCID: PMC3925113 DOI: 10.1371/journal.pone.0088157] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
Female sex workers (FSW) are often the focus of primary HIV prevention efforts. However, little attention has been paid to the prevention, treatment, and care needs of FSW living with HIV. Based on formative research, we developed an integrated model to promote prevention and care for FSW living with HIV in Santo Domingo, Dominican Republic, including (1) individual counseling and education; (2) peer navigation; (3) clinical provider training; and (4) community mobilization. We enrolled 268 FSW living with HIV into the intervention and conducted socio-behavioral surveys, sexually transmitted infection (STI) testing, and viral load (VL) assessments. We used multivariate logistic regression to identify behavioral and socio-demographic factors associated with detectable VL (>50 copies/mL) and STI prevalence. Over half of all participants (51.9%) had a detectable VL, even though most received HIV-related care in the last 6 months (85.1%) and were currently on anti-retroviral treatment (ART) (72.4%). Factors positively associated with a detectable VL included being 18-35 years of age (Adjusted Odds Ratio [AOR] 2.46, 95% CI 1.31-4.60), having ever used drugs (AOR 2.34, 95% CI 1.14-4.79), and having ever interrupted ART (AOR 3.09, 95% CI 1.44-6.59). Factors protective against having a detectable VL included being single (AOR 0.45, 95% 0.20-0.98) and being currently on ART (AOR 0.17, 95% CI 0.07-0.41). Nearly one-quarter (23.1%) had an STI, which was associated with being single (AOR 3.21, 95% CI 1.27-8.11) and using drugs in the last 6 months (AOR 3.54, 95% CI 1.32-9.45). Being on ART was protective against STI (AOR 0.51, 95% CI 0.26-1.00). Baseline findings indicate significant barriers to VL suppression and STI prevention among FSW living with HIV and highlight gaps in the continuum of HIV care and treatment. These findings have important implications for both the individual health of FSW and population-level HIV transmission dynamics.
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Affiliation(s)
- Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Rep. Dom
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Rep. Dom
| | - Deanna Kerrigan
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Jiang J, Yang X, Ye L, Zhou B, Ning C, Huang J, Liang B, Zhong X, Huang A, Tao R, Cao C, Chen H, Liang H. Pre-exposure prophylaxis for the prevention of HIV infection in high risk populations: a meta-analysis of randomized controlled trials. PLoS One 2014; 9:e87674. [PMID: 24498350 PMCID: PMC3912017 DOI: 10.1371/journal.pone.0087674] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nearly ten randomized controlled trials (RCTs) of pre-exposure prophylaxis (PrEP) have been completed or are ongoing worldwide to evaluate the effectiveness of PrEP in HIV transmission among HIV-uninfected high risk populations. The purpose of this study was to evaluate the role of PrEP to prevent HIV transmission through a Mata-analysis. METHODS A comprehensive computerized literature search was carried out in PubMed, EMbase, Ovid, Web of Science, Science Direct, Wan Fang, CNKI and related websites to collect relevant articles (from their establishment date to August 30, 2013). The search terms were "pre-exposure prophylaxis", "high risk population", "HIV infection", "reduction", "relative risk" and "efficacy". We included any RCT assessing PrEP for the prevention of HIV infection in high risk populations. Interventions of the studies were continuously daily or intermittent doses of single or compound antiretrovirals (ARVs) before HIV exposure or during HIV exposure. A meta-analysis was conducted using Stata 10.0. A random-effects method was used to calculate the pooled relative risk (RR) and 95% confidence intervals (CI) for all studies included. RESULTS Seven RCTs involving 14,804 individuals in high risk populations were eligible for this study. The number of subjects in the experimental groups was 8,195, with HIV infection rate of 2.03%. The number of subjects in the control groups was 6,609, with HIV infection rate of 4.07%. The pooled RR was 0.53 (95% CI = 0.40 ∼ 0.71, P<0.001). The re-analyzed pooled RR were 0.61 (95% CI = 0.48 ∼ 0.77, P<0.001), 0.49 (95% CI = 0.38 ∼ 0.63, P<0.001), respectively, by excluding the largest study or two studies without statistical significance. Publication bias analysis revealed a symmetry funnel plot. The fail-safe number was 1,022. CONCLUSION These results show that PrEP is an effective strategy for reducing new HIV infections in high risk populations.
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Affiliation(s)
- Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoyi Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bo Zhou
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
| | - Chuanyi Ning
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ailong Huang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Renchuan Tao
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
| | - Cunwei Cao
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
| | - Hui Chen
- Geriatrics Digestion Department of Internal Medicine, The First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, Guangxi, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
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Balán IC, Carballo-Diéguez A, Frasca T, Dolezal C, Ibitoye M. The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS Behav 2014; 18:254-62. [PMID: 23657758 DOI: 10.1007/s10461-013-0497-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study explores the sexual behavior of 27 men who have sex with men (MSM) who regularly engage in unprotected anal intercourse (UAI), in the context of HIV home test (HT) use with potential sex partners. Participants were given 16 HT kits to use over 3 months. Among 40 sexual occasions following HIV-negative HT results, there were 25 UAI occasions (16 based on not typically using condoms and nine on HT results), 15 occasions in which condoms were used, and three in which sex did not occur. In the seven occasions where a potential partner received HIV-positive HT results, the sexual encounter ended. Almost all participants encountered potential partners who refused HT. Over half of these participants ended sexual encounters when HT was refused, perceiving these partners as HIV-positive or too high risk. Some participants reported that HT use heightened their awareness of HIV risk and their commitment to reducing it.
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Affiliation(s)
- Iván C Balán
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA,
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