BACKGROUND: Preexposure prophylaxis (PrEP) greatly reduces the risk of human immunodeficiency virus (HIV) acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery. METHODS: To quantify the added value of STI clinic-based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected 20-year reduction in HIV incidence among MSM. RESULTS: Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range, 14%-18%] over 20 years, an impact that was 1.8 (1.7-2.0) times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (ie, evaluating more individuals for PrEP in the community-based strategy, because MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 (1.3-1.4) times as great as that of community-based delivery. CONCLUSIONS: Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.
BACKGROUND: Preexposure prophylaxis (PrEP) greatly reduces the risk of human immunodeficiency virus (HIV) acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery. METHODS: To quantify the added value of STI clinic-based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected 20-year reduction in HIV incidence among MSM. RESULTS: Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range, 14%-18%] over 20 years, an impact that was 1.8 (1.7-2.0) times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (ie, evaluating more individuals for PrEP in the community-based strategy, because MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 (1.3-1.4) times as great as that of community-based delivery. CONCLUSIONS: Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.
Authors: Robert M Grant; Javier R Lama; Peter L Anderson; Vanessa McMahan; Albert Y Liu; Lorena Vargas; Pedro Goicochea; Martín Casapía; Juan Vicente Guanira-Carranza; Maria E Ramirez-Cardich; Orlando Montoya-Herrera; Telmo Fernández; Valdilea G Veloso; Susan P Buchbinder; Suwat Chariyalertsak; Mauro Schechter; Linda-Gail Bekker; Kenneth H Mayer; Esper Georges Kallás; K Rivet Amico; Kathleen Mulligan; Lane R Bushman; Robert J Hance; Carmela Ganoza; Patricia Defechereux; Brian Postle; Furong Wang; J Jeff McConnell; Jia-Hua Zheng; Jeanny Lee; James F Rooney; Howard S Jaffe; Ana I Martinez; David N Burns; David V Glidden Journal: N Engl J Med Date: 2010-11-23 Impact factor: 91.245
Authors: Merlin L Robb; Leigh A Eller; Hannah Kibuuka; Kathleen Rono; Lucas Maganga; Sorachai Nitayaphan; Eugene Kroon; Fred K Sawe; Samuel Sinei; Somchai Sriplienchan; Linda L Jagodzinski; Jennifer Malia; Mark Manak; Mark S de Souza; Sodsai Tovanabutra; Eric Sanders-Buell; Morgane Rolland; Julie Dorsey-Spitz; Michael A Eller; Mark Milazzo; Qun Li; Andrew Lewandowski; Hao Wu; Edith Swann; Robert J O'Connell; Sheila Peel; Peter Dawson; Jerome H Kim; Nelson L Michael Journal: N Engl J Med Date: 2016-05-18 Impact factor: 91.245
Authors: Douglas S Krakower; Matthew J Mimiaga; Joshua G Rosenberger; David S Novak; Jennifer A Mitty; Jaclyn M White; Kenneth H Mayer Journal: PLoS One Date: 2012-03-28 Impact factor: 3.240
Authors: Ryan D Assaf; Nicole J Cunningham; Paul C Adamson; Jamieson Trevor Jann; Robert K Bolan Journal: Sex Transm Infect Date: 2022-02-25 Impact factor: 4.199
Authors: Kevin F Kamis; Grace E Marx; Kenneth A Scott; Edward M Gardner; Karen A Wendel; Mia L Scott; Angela E Montgomery; Sarah E Rowan Journal: Open Forum Infect Dis Date: 2019-06-27 Impact factor: 3.835
Authors: Carmen Hidalgo-Tenorio; Concepción Gil-Anguita; Miguel Angel López Ruz; Mohamed Omar; Javier López-Hidalgo; Juan Pasquau Journal: PLoS One Date: 2019-10-24 Impact factor: 3.240