Effect of Racial Inequities in Pre-exposure Prophylaxis Use on Racial Disparities in HIV Incidence Among Men Who Have Sex With Men: A Modeling Study.
Effect of Racial Inequities in Pre-exposure Prophylaxis Use on Racial Disparities in HIV Incidence Among Men Who Have Sex With Men: A Modeling Study.
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DOI：
10.1097/qai.0000000000001817
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发表时间：
2018-11-01
期刊：
影响因子：
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通讯作者：
Marshall BDL
中科院分区：
文献类型：
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作者：
Goedel WC;King MRF;Lurie MN;Nunn AS;Chan PA;Marshall BDL
在美国，与男性发生性关系的非洲裔美国男性（AAMSM）中暴露前预防（PrEP）的吸收缓慢。我们使用基于代理的模型（ABM）来模拟种族特异性PrEP覆盖率，以估计其对格鲁吉亚亚特兰大市男男性接触者艾滋病发病率种族差异的影响。建立了一个ABM来模拟从2015年开始的十年内10，000名MSM的动态网络中的艾滋病毒传播。我们模拟了一个基础场景，AAMSM和白色MSM（WMSM）中PrEP覆盖率估计为2.5%。然后，我们比较了十年来的艾滋病毒发病率，并计算了不同PrEP规模扩大情况下AAMSM与WMSM发病率的差异比，AAMSM和WMSM之间的覆盖率相等和不相等。假设目前的覆盖率保持不变，该模型预测艾滋病毒的发病率为2.95和1.76每100人-年之间的AAMSM和WMSM分别为1.68的差距比。如果PrEP覆盖率增加6倍而不解决PrEP摄取的不平等，该模型预测发病率为2.65和1.34，分别对应于艾滋病毒发病率平均下降10.4%和24.0%。WMSM的这一更强的益处使差异比率增加到1.98。AAMSM和WMSM之间的PrEP覆盖率相等，导致整体发病率较低，差异比率较低。AAMSM相对于WMSM的吸收率较低可能会限制AAMSM中PrEP使用的人口水平影响，这可能最终导致MSM中艾滋病毒发病率的种族差异更大。
Pre-exposure prophylaxis (PrEP) uptake has been slow among African American men who have sex with men (AAMSM) in the United States. We used an agent-based model (ABM) to simulate race-specific PrEP coverage to estimate their impact on racial disparities in HIV incidence among MSM in Atlanta, Georgia. An ABM was constructed to simulate HIV transmission in a dynamic network of 10,000 MSM over ten years, beginning in 2015. We modeled a base scenario with estimated PrEP coverage of 2.5% among AAMSM and 5.0% among white MSM (WMSM). We then compared HIV incidence over ten years and calculated a disparity ratio of AAMSM to WMSM incidence rates across varying PrEP scale-up scenarios, with equal and unequal coverage among AAMSM and WMSM. Assuming current coverage remains constant, the model predicts HIV incidence rates of 2.95 and 1.76 per 100 person-years among AAMSM and WMSM respectively, with a disparity ratio of 1.68. If PrEP coverage were to increase six-fold without addressing inequities in PrEP uptake, the model predicts incidences of 2.65 and 1.34, corresponding to a mean decrease of 10.4% and 24.0% in HIV incidence, respectively. This stronger benefit for WMSM increased the disparity ratio to 1.98. Equal PrEP coverage among AAMSM and WMSM resulted in lower incidence rates overall with lower disparity ratios. Lower uptake among AAMSM relative to WMSM may limit the population-level impact of PrEP use among AAMSM, which may ultimately culminate in wider racial disparities in HIV incidence among MSM.