The Potential Impact of Pre-Exposure Prophylaxis for HIV Prevention among Men Who Have Sex with Men and Transwomen in Lima, Peru: A Mathematical Modelling Study
The Potential Impact of Pre-Exposure Prophylaxis for HIV Prevention among Men Who Have Sex with Men and Transwomen in Lima, Peru: A Mathematical Modelling Study
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DOI：
10.1371/journal.pmed.1001323
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发表时间：
2012-10-01
期刊：
影响因子：
15.8
通讯作者：
Hallett, Timothy B.
中科院分区：
文献类型：
--
作者：
Gomez, Gabriela B.;Borquez, Annick;Hallett, Timothy B.
背景资料：艾滋病毒暴露前预防（PrEP），即未感染者使用抗逆转录病毒药物预防艾滋病毒感染，已证明在预防男性同性性行为（MSM）高危人群中获得艾滋病毒方面有效。因此，有必要了解是否以及如何PrEP可以使用具有成本效益的，以防止艾滋病毒感染在这样的population.Methods和调查结果：我们开发了一个数学模型，代表艾滋病毒流行的男男性行为者和transwomen（男性到女性的变性人）在利马，秘鲁，作为一个测试案例。假设模型中的PrEP有效性由“条件有效性”参数和依从性参数的组合产生。从卫生提供者的角度来看，年度运营成本是基于美国疾病控制和预防中心的PrEP使用临时指南。该模型被用来调查人口水平的影响，成本和成本效益的PrEP在一系列的实施方案。PrEP的流行病学影响很大程度上取决于项目特征。对于5%的适度PrEP覆盖率，在优先考虑高风险人群并达到暴露前预防倡议研究的依从性水平的计划中，可以避免超过8%的感染。在所有情景中，避免的每个残疾调整生命年的最高估计成本（覆盖率为20%的统一战略，1，036 - 4，254美元）低于世界卫生组织建议的具有成本效益的干预措施的阈值，而只有某些乐观的情景（5%的低覆盖率和一些或高优先级）可能具有成本效益。如果PrEP减少避孕套的使用，PrEP的影响就会减少，但只有非坚持者的极端行为变化（避孕套使用减少80%以上）和PrEP条件有效性低（40%）才会对流行病产生不利影响。然而，PrEP将不会逮捕艾滋病毒的传播隔离，因为其不完整的有效性和依赖于坚持，因为高成本的方案限制了覆盖水平，可以潜在地实现.Conclusions：一个战略性的PrEP干预措施可能是一个具有成本效益的除了现有的艾滋病毒预防策略的男男性接触人群。然而，尽管具有成本效益，但需要大量支出才能大幅降低发病率。
Background: HIV pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by uninfected individuals to prevent HIV infection, has demonstrated effectiveness in preventing acquisition in a high-risk population of men who have sex with men (MSM). Consequently, there is a need to understand if and how PrEP can be used cost-effectively to prevent HIV infection in such populations.Methods and Findings: We developed a mathematical model representing the HIV epidemic among MSM and transwomen (male-to-female transgender individuals) in Lima, Peru, as a test case. PrEP effectiveness in the model is assumed to result from the combination of a "conditional efficacy" parameter and an adherence parameter. Annual operating costs from a health provider perspective were based on the US Centers for Disease Control and Prevention interim guidelines for PrEP use. The model was used to investigate the population-level impact, cost, and cost-effectiveness of PrEP under a range of implementation scenarios. The epidemiological impact of PrEP is largely driven by programme characteristics. For a modest PrEP coverage of 5%, over 8% of infections could be averted in a programme prioritising those at higher risk and attaining the adherence levels of the Pre-Exposure Prophylaxis Initiative study. Across all scenarios, the highest estimated cost per disability-adjusted life year averted (uniform strategy for a coverage level of 20%, US$1,036-US$4,254) is below the World Health Organization recommended threshold for cost-effective interventions, while only certain optimistic scenarios (low coverage of 5% and some or high prioritisation) are likely to be cost-effective using the World Bank threshold. The impact of PrEP is reduced if those on PrEP decrease condom use, but only extreme behaviour changes among non-adherers (over 80% reduction in condom use) and a low PrEP conditional efficacy (40%) would adversely impact the epidemic. However, PrEP will not arrest HIV transmission in isolation because of its incomplete effectiveness and dependence on adherence, and because the high cost of programmes limits the coverage levels that could potentially be attained.Conclusions: A strategic PrEP intervention could be a cost-effective addition to existing HIV prevention strategies for MSM populations. However, despite being cost-effective, a substantial expenditure would be required to generate significant reductions in incidence.