PrEP for key populations in combination HIV prevention in Nairobi: a mathematical modelling study
| Autor: | Gloria Gakii, Timothy B. Hallett, Katharine Kripke, Wes Hinsley, Lawrence Gelmon, Ide Cremin, Joshua Kimani, Peter Cherutich, Lyle R. McKinnon, Michael Kiragu, Jennifer A. Smith, Festus K. Muriuki, Robert Hecht |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Program evaluation Adult Male Epidemiology Anti-HIV Agents media_common.quotation_subject Immunology Population Psychological intervention Context (language use) HIV Infections Article Men who have sex with men law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Condom law Virology Medicine Humans 030212 general & internal medicine Homosexuality Homosexuality Male education Epidemics media_common education.field_of_study Sex Workers business.industry Risk of infection virus diseases Models Theoretical 030112 virology Kenya Infectious Diseases Female Pre-Exposure Prophylaxis business Demography |
| Zdroj: | The lancet. HIV. 4(5) |
| ISSN: | 2352-3018 |
| Popis: | Summary Background The HIV epidemic in the population of Nairobi as a whole is in decline, but a concentrated sub-epidemic persists in key populations. We aimed to identify an optimal portfolio of interventions to reduce HIV incidence for a given budget and to identify the circumstances in which pre-exposure prophylaxis (PrEP) could be used in Nairobi, Kenya. Methods A mathematical model was developed to represent HIV transmission in specific key populations (female sex workers, male sex workers, and men who have sex with men [MSM]) and among the wider population of Nairobi. The scale-up of existing interventions (condom promotion, antiretroviral therapy, and male circumcision) for key populations and the wider population as have occurred in Nairobi is represented. The model includes a detailed representation of a PrEP intervention and is calibrated to prevalence and incidence estimates specific to key populations and the wider population. Findings In the context of a declining epidemic overall but with a large sub-epidemic in MSM and male sex workers, an optimal prevention portfolio for Nairobi should focus on condom promotion for male sex workers and MSM in particular, followed by improved antiretroviral therapy retention, earlier antiretroviral therapy, and male circumcision as the budget allows. PrEP for male sex workers could enter an optimal portfolio at similar levels of spending to when earlier antiretroviral therapy is included; however, PrEP for MSM and female sex workers would be included only at much higher budgets. If PrEP for male sex workers cost as much as US$500, average annual spending on the interventions modelled would need to be less than $3·27 million for PrEP for male sex workers to be excluded from an optimal portfolio. Estimated costs per infection averted when providing PrEP to all female sex workers regardless of their risk of infection, and to high-risk female sex workers only, are $65 160 (95% credible interval [CrI] $43 520–$90 250) and $10 920 (95% CrI $4700–$51 560), respectively. Interpretation PrEP could be a useful contribution to combination prevention, especially for under-served key populations in Nairobi. An ongoing demonstration project will provide important information regarding practical aspects of implementing PrEP for key populations in this setting. Funding The Bill & Melinda Gates Foundation. |
| Databáze: | OpenAIRE |
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