Impact of Providing Preexposure Prophylaxis for Human Immunodeficiency Virus at Clinics for Sexually Transmitted Infections in Baltimore City: An Agent-based Model.
Impact of Providing Preexposure Prophylaxis for Human Immunodeficiency Virus at Clinics for Sexually Transmitted Infections in Baltimore City: An Agent-based Model.
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DOI：
10.1097/olq.0000000000000882
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发表时间：
2018-12
影响因子：
3.1
通讯作者：
Dowdy DW
中科院分区：
文献类型：
--
作者：
Kasaie P;Berry SA;Shah MS;Rosenberg ES;Hoover KW;Gift TL;Chesson H;Pennington J;German D;Flynn CP;Beyrer C;Dowdy DW
暴露前预防（PrEP）大大降低了感染艾滋病毒的风险，但其最佳给药策略仍不确定。性传播感染 (STI) 诊所可以提供高效的 PrEP 实施场所。为了量化基于 STI 诊所的 PrEP 交付的附加值，我们使用基于代理的方法模拟男男性行为者 (MSM) 中的 HIV 传播。我们模拟了通过 STI 诊所提供 PrEP 与在其他社区环境中提供 PrEP 的影响进行比较。我们的主要成果是预计 MSM 中艾滋病毒发病率将在 20 年内下降。假设 PrEP 的采用率和依从性均为 60%，评估性传播感染诊所的参加者并向符合条件的 MSM 提供 PrEP 可以在 20 年内将 HIV 发病率降低 16% [95% 不确定性范围：14% – 18%]，其影响是评估从社区招募的同等数量 MSM 所取得的效果的 1.8 [1.7 – 2.0] 倍。比较每种策略中相同数量的 MSM 接受 PrEP 的策略（即，在基于社区的策略中评估更多个体的 PrEP，因为参加 STI 诊所的 MSM 更有可能符合 PrEP 资格），基于 STI 诊所的策略下的 HIV 发病率降低幅度是基于社区的策略的 1.3 [1.3 – 1.4] 倍。向参加 STI 诊所的 MSM 提供 PrEP 可以提高效率和效果。如果该人群能够实现高水平的依从性，性传播感染诊所可能成为实施 PrEP 的重要场所。性传播感染诊所是通过提高筛查效率和 PrEP 有效性，在男男性行为者中实施暴露前预防 (PrEP) 的高效场所。
Pre-exposure prophylaxis (PrEP) greatly reduces the risk of HIV acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery. To quantify the added value of STI clinic–based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected twenty-year reduction in HIV incidence among MSM. Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range: 14% – 18%] over 20 years, an impact that was 1.8 [1.7 – 2.0] times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (i.e., evaluating more individuals for PrEP in the community-based strategy, since MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 [1.3 – 1.4] times as great as that of community-based delivery. Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation. Clinics for sexually transmitted infections are highly effective venues for implementation of pre-exposure prophylaxis (PrEP) among men who have sex with men by improving efficiency of screening and effectiveness of PrEP.