Mathematical Model Impact Analysis of a Real-Life Pre-exposure Prophylaxis and Treatment-As-Prevention Study Among Female Sex Workers in Cotonou, Benin.
Mathematical Model Impact Analysis of a Real-Life Pre-exposure Prophylaxis and Treatment-As-Prevention Study Among Female Sex Workers in Cotonou, Benin.
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DOI：
10.1097/qai.0000000000002535
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发表时间：
2021-02-01
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影响因子：
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通讯作者：
Boily MC
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作者：
Geidelberg L;Mitchell KM;Alary M;Mboup A;Béhanzin L;Guédou F;Geraldo N;Goma-Matsétsé E;Giguère K;Aza-Gnandji M;Kessou L;Diallo M;Kêkê RK;Bachabi M;Dramane K;Lafrance C;Affolabi D;Diabaté S;Gagnon MP;Zannou DM;Gangbo F;Silhol R;Cianci F;Vickerman P;Boily MC
文本中提供了补充数字内容。每日暴露前预防 (PrEP) 和预防治疗 (TasP) 分别可降低 HIV 感染和传播风险。一项示范研究（2015-2017 年）评估了贝宁科托努女性性工作者 (FSW) 中 TasP 和 PrEP 的可行性。贝宁科托努。我们开发了一种在高风险（FSW 和客户）和低风险人群中采用 PrEP 和抗逆转录病毒治疗 (ART) 的分区 HIV 传播模型，并根据历史流行病学和示范研究数据进行校准，反映出与 TasP 相比，观察到的 PrEP 吸收、依从性和保留率较低。我们估计了这项为期 2 年的研究和几个 20 年的干预方案对人口水平的影响，分别独立和共同改变了覆盖范围和依从性。我们报告了与干预和反事实（2017 年覆盖率：0% PrEP 和 49% ART）情景相比，艾滋病毒感染的百分比[中位数，第 2.5-97.5 个百分位数不确定区间 (95% UI)]。这项为期 2 年的研究（2017 年覆盖率：9% PrEP 和 83% ART）在 2 年和 20 年内分别预防了 8% (95% UI 6-12) 和 6% (3-10) 的 FSW 感染，而总体预防率为 7% (3-11) 和 5% (2-9)。 20 年来，PrEP 和 TasP 组分别预防了 0.4%（0.2-0.8）和 4.6%（2.2-8.7）的感染。二十年的 PrEP 和 TasP 扩大规模（2035 年覆盖率：47% PrEP 和 88% ART）在 FSW 中分别预防了 21% (17-26) 和 17% (10-27) 的感染，总体预防率分别为 5% (3-10) 和 17% (10-27)。与单独扩大 TasP 相比，PrEP 和 TasP 联合扩大规模分别预防了 FSW 和总体感染的 1.9 倍和 1.2 倍。示范研究的影响不大，而且主要来自 TasP。增加 PrEP 依从性和覆盖范围可显着改善 FSW 的影响，但总体影响不大。我们推荐将 TasP 纳入预防包中。
Supplemental Digital Content is Available in the Text. Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015–2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin. Cotonou, Benin. We developed a compartmental HIV transmission model featuring PrEP and antiretroviral therapy (ART) among the high-risk (FSW and clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared with TasP. We estimated the population-level impact of the 2-year study and several 20-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage [median, 2.5th–97.5th percentile uncertainty interval (95% UI)] of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP and 49% ART) scenarios. The 2-year study (2017 coverages: 9% PrEP and 83% ART) prevented an estimated 8% (95% UI 6–12) and 6% (3–10) infections among FSW over 2 and 20 years, respectively, compared with 7% (3–11) and 5% (2–9) overall. The PrEP and TasP arms prevented 0.4% (0.2–0.8) and 4.6% (2.2–8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP and 88% ART) prevented 21% (17–26) and 17% (10–27) infections among FSW, respectively, and 5% (3–10) and 17% (10–27) overall. Compared with TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9× and 1.2× more infections among FSW and overall, respectively. The demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages.