Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York.
Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York.
复制标题
DOI：
10.1097/qad.0000000000000460
复制
发表时间：
2014-11-28
期刊：
影响因子：
--
通讯作者：
Braithwaite S
中科院分区：
文献类型：
--
作者：
Kessler J;Myers JE;Nucifora KA;Mensah N;Toohey C;Khademi A;Cutler B;Braithwaite S
目的比较不同暴露前预防(PrEP)优先策略在纽约市的价值和效果。将数学模型用于临床试验是不可行的。使用一个同时考虑艾滋病毒的性传播和肠道外传播的模型，我们比较了两种情况下PrEP的不同优先顺序策略(PPS)-没有PrEP和所有易感高危个体的PrEP。PPS包括为所有MSM、仅为高危MSM、高危异性恋者和注射吸毒者提供PrEP，以及这四种策略的所有组合。结果包括避免了艾滋病毒感染，以及增量成本效益(避免每次感染)比率。关于PrEP的初步假设包括艾滋病毒传播率降低44%，优先人群感染率下降50%，人均年成本为9,762美元。对关键参数进行了敏感性分析。对所有男男性接触者进行优先处理可使新感染艾滋病毒的人数减少19%。与针对所有高危人群的PrEP相比，这种PPS以总成本的15%保留了79%的预防效果。仅优先考虑高危男男性接触者可使新感染艾滋病毒的人数减少15%。这项PPS以总成本的6%保留了60%的预防效果。当PrEP利用率扩展到这一组之外时，回报会递减。在我们最初的假设下，准备实施的成本效率相对较低。我们的结果表明，应首先在感染艾滋病毒风险特别高的男男性接触者中推广PrEP。在这一群体之外进一步扩张可能具有成本效益，但不太可能节省成本。
To compare the value and effectiveness of different prioritization strategies of pre-exposure prophylaxis (PrEP) in New York City (NYC). Mathematical modeling utilized as clinical trial is not feasible. Using a model accounting for both sexual and parenteral transmission of HIV we compare different prioritization strategies (PPS) for PrEP to two scenarios—no PrEP and PrEP for all susceptible at-risk individuals. The PPS included PrEP for all MSM, only high-risk MSM, high-risk heterosexuals, and injection drug users, and all combinations of these four strategies. Outcomes included HIV infections averted, and incremental cost effectiveness (per-infection averted) ratios. Initial assumptions regarding PrEP included a 44% reduction in HIV transmission, 50% uptake in the prioritized population and an annual cost per person of $9,762. Sensitivity analyses on key parameters were conducted. Prioritization to all MSM results in a 19% reduction in new HIV infections. Compared to PrEP for all persons at-risk this PPS retains 79% of the preventative effect at 15% of the total cost. PrEP prioritized to only high-risk MSM results in a reduction in new HIV infections of 15%. This PPS retains 60% of the preventative effect at 6% of the total cost. There are diminishing returns when PrEP utilization is expanded beyond this group. PrEP implementation is relatively cost-inefficient under our initial assumptions. Our results suggest that PrEP should first be promoted among MSM who are at particularly high-risk of HIV acquisition. Further expansion beyond this group may be cost-effective, but is unlikely to be cost-saving.