Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision.
Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision.
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DOI：
10.1371/journal.pone.0244761
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Bershteyn A
中科院分区：
文献类型：
--
作者：
Mudimu E;Peebles K;Mukandavire Z;Nightingale E;Sharma M;Medley GF;Klein DJ;Kripke K;Bershteyn A
暴露前预防（PrEP）在预防艾滋病毒方面非常有效，并有可能对艾滋病毒流行产生重大影响。鉴于艾滋病毒预防资源有限，确定最大限度地发挥影响的PrEP提供战略至关重要。我们使用了一个随机的基于个人的网络模型来评估PrEP的直接（预防PrEP用户之间的感染）和间接（预防非PrEP用户之间的感染）PrEP的好处，预防一次HIV感染所需的PrEP人年，以及向肯尼亚西部和南非按性别和年龄定义的人群提供PrEP的社区影响。我们通过比较两种情况来检查结果对扩大抗逆转录病毒治疗（ART）和自愿医疗男性包皮环切术（VMMC）的敏感性：保持目前的覆盖率（“现状”）和快速扩大以实现计划目标（“快速通道”）。由于发病率高，PrEP对15-24岁女性的社区影响最大，而15-24岁男性使用PrEP在社区预防间接感染的比例最高。相对于PrEP使用者预防的直接感染，这些预防的间接感染随着时间的推移继续增加（肯尼亚西部：0.4-5.5（现状）; 0.4-4.9（快速通道）;南非：0.5-1.8（现状）; 0.5-3.0（快速通道））。预防一次艾滋病毒感染所需的PrEP人年数较低（在现状情景中，肯尼亚西部为59人，南非为69人;在快速通道情景中，肯尼亚西部为201人，南非为87人），当仅向女性提供PrEP时，与仅向男性提供PrEP相比，在长达5年的时间范围内，为男性提供PrEP的间接好处在以后几年中累积。为15-24岁的女性提供PrEP可以防止每人年PrEP感染艾滋病毒的最大数量，但为年轻男性提供PrEP也为女性和整个社区提供了间接利益。这一发现支持了优先考虑年轻女性使用PrEP的现有政策，同时也阐明了在资源允许的情况下，PrEP对男性的社区层面益处。
Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV and has the potential to significantly impact the HIV epidemic. Given limited resources for HIV prevention, identifying PrEP provision strategies that maximize impact is critical. We used a stochastic individual-based network model to evaluate the direct (infections prevented among PrEP users) and indirect (infections prevented among non-PrEP users as a result of PrEP) benefits of PrEP, the person-years of PrEP required to prevent one HIV infection, and the community-level impact of providing PrEP to populations defined by gender and age in western Kenya and South Africa. We examined sensitivity of results to scale-up of antiretroviral therapy (ART) and voluntary medical male circumcision (VMMC) by comparing two scenarios: maintaining current coverage (“status quo”) and rapid scale-up to meet programmatic targets (“fast-track”). The community-level impact of PrEP was greatest among women aged 15–24 due to high incidence, while PrEP use among men aged 15–24 yielded the highest proportion of indirect infections prevented in the community. These indirect infections prevented continue to increase over time (western Kenya: 0.4–5.5 (status quo); 0.4–4.9 (fast-track); South Africa: 0.5–1.8 (status quo); 0.5–3.0 (fast-track)) relative to direct infections prevented among PrEP users. The number of person-years of PrEP needed to prevent one HIV infection was lower (59 western Kenya and 69 in South Africa in the status quo scenario; 201 western Kenya and 87 in South Africa in the fast-track scenario) when PrEP was provided only to women compared with only to men over time horizons of up to 5 years, as the indirect benefits of providing PrEP to men accrue in later years. Providing PrEP to women aged 15–24 prevents the greatest number of HIV infections per person-year of PrEP, but PrEP provision for young men also provides indirect benefits to women and to the community overall. This finding supports existing policies that prioritize PrEP use for young women, while also illuminating the community-level benefits of PrEP availability for men when resources permit.
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DOI：
10.1016/s2352-3018(17)30156-x
发表时间：
2018-03
期刊：
The lancet. HIV
影响因子：
--
作者：
Bekker LG;Roux S;Sebastien E;Yola N;Amico KR;Hughes JP;Marzinke MA;Hendrix CW;Anderson PL;Elharrar V;Stirratt M;Rooney JF;Piwowar-Manning E;Eshleman SH;McKinstry L;Li M;Dye BJ;Grant RM;HPTN 067 (ADAPT) study team
通讯作者：
HPTN 067 (ADAPT) study team
DOI：
10.1126/science.1228160
发表时间：
2013-02-22
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Tanser F;Bärnighausen T;Grapsa E;Zaidi J;Newell ML
通讯作者：
Newell ML
影响因子：
8.8
作者：
Bershteyn, Anna;Mutai, Kennedy K.;Mwalili, Samuel M.
通讯作者：
Mwalili, Samuel M.
影响因子：
4.6
作者：
Selinger, Christian;Dimitrov, Dobromir T.;Bershteyn, Anna
通讯作者：
Bershteyn, Anna
影响因子：
3.3
作者：
Bershteyn, Anna;Gerardin, Jaline;Wiswell, Christian N.
通讯作者：
Wiswell, Christian N.