Can the combination of TasP and PrEP eliminate HIV among MSM in British Columbia, Canada?

Lima, Viviane D.; Zhu, Jielin; Card, Kiffer G.; Lachowsky, Nathan J.; Chowell‐Puente, Gerardo; Wu, Zunyou; Montaner, Julio S. G.

doi:10.1016/j.epidem.2021.100461

Cited by 8 publications

(13 citation statements)

References 45 publications

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“…1 were estimated through either literature or calibration ( Supporting Information in Supplementary Tables S1 and S2 ). The model was calibrated to fit the HIV and syphilis epidemic indicators in BC from multiple data sources: (1) the estimates of HIV prevalence and incidence of the MSM population from the Public Health Agency of Canada 25 ; (2) the estimated percentages of MSM diagnosed with HIV, MSM with ART initiation, and MSM currently on ART from our previous modelling study, based on historical data obtained from the BC Centre for Excellence in HIV/AIDS (BC-CfE) 12 ; (3) the annual number of HIV diagnosis among MSM obtained from the BC-CfE 11 ; and (4) the annual number of infectious syphilis diagnosis among all MSM in BC, and the percentage of those diagnosed with HIV obtained from annual reports from the BC Centre for Disease Control. 26 In addition, to account for the impact of the HIV-PrEP program in BC, the model was calibrated to fit the number of infectious syphilis and HIV diagnoses among active HIV-PrEP users in 2018 and 2019.…”

Section: Methodsmentioning

confidence: 99%

“…26 In addition, to account for the impact of the HIV-PrEP program in BC, the model was calibrated to fit the number of infectious syphilis and HIV diagnoses among active HIV-PrEP users in 2018 and 2019. 12 , 24 The MSM population was assumed to grow over time and the size of the population was assumed to be 50,900 in 2015. 27…”

Section: Methodsmentioning

confidence: 99%

“…11 According to a recent mathematical modelling study, HIV elimination in BC was possible with TasP optimization and further expansion of HIV-PrEP to high-risk MSM, which achieved less than one new HIV case per 1,000 susceptible MSM as early as 2024. 12 …”

Section: Introductionmentioning

confidence: 99%

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Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Zhu,

Takeh,

David

et al. 2024

The Lancet Regional Health - Americas

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Zhu,

Takeh,

David

et al. 2024

The Lancet Regional Health - Americas

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“…These focused interventions have allowed limited public health resources to be allocated with greater efficiency and 8 years of using this method to track and respond to the epidemic have contributed to substantial decreases in new HIV diagnoses [ 6 , 7 ]. Decreasing diagnoses are likely also driven in part by improved access to antiretroviral therapy (ART), the expansion of harm reduction strategies [ 8 ], and increased uptake of pre-exposure prophylaxis (PrEP) following the 2018 decision to provide PrEP to eligible individuals at no cost [ 9 ]. Additionally, phylogenetic monitoring has allowed fine-grained inferences about trends in the BC epidemic, such as the number of new cases joining clusters over time, a metric quantifying local transmission shown by our dataset to have consistently declined over the past 8 years ( Fig.…”

Section: Background and Objectivesmentioning

confidence: 99%

Phylogenetic prioritization of HIV-1 transmission clusters with viral lineage-level diversification rates

Miller

McLaughlin

Liang

et al. 2022

Evolution, Medicine, and Public Health

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Background and objectives Public health officials faced with a large number of transmission clusters require a rapid, scalable, and unbiased way to prioritize distribution of limited resources to maximize benefits. We hypothesize that transmission cluster prioritization based on phylogenetically-derived lineage-level diversification rates will perform as well as or better than commonly used growth-based prioritization measures, without need for historical data or subjective interpretation. Methodology 9822 HIV pol sequences collected during routine drug resistance genotyping were used alongside simulated sequence data to infer sets of phylogenetic transmission clusters via patristic distance threshold. Prioritized clusters inferred from empirical data were compared to those prioritized by the current public health protocols. Prioritization of simulated clusters was evaluated based on correlation of a given prioritization measure with future cluster growth, as well as the number of direct downstream transmissions from cluster members. Results Empirical data suggest diversification rate-based measures perform comparably to growth-based measures in recreating public heath prioritization choices. However, unbiased simulated data reveals phylogenetic diversification rate-based measures perform better in predicting future cluster growth relative to growth-based measures, particularly long-term growth. Diversification rate-based measures also display advantages over growth-based measures in highlighting groups with greater future transmission events compared to random groups of the same size. Furthermore, diversification rate measures were notably more robust to effects of decreased sampling proportion. Conclusions and implications Our findings indicate diversification rate-based measures frequently outperform growth-based measures in predicting future cluster growth and offer several additional advantages beneficial to optimizing the public health prioritization process. Lay Summary Public health officials faced with more transmitting groups than can be immediately addressed require an efficient way to prioritize limited resources. We demonstrate that phylogenetic approximations of transmission derived from viral sequence data offer advantages over other common methods of prioritizing clusters, while meeting and frequently exceeding existing performance standards.

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“…PrEP is not just an individual-level clinical tool but should also be understood as a public health intervention like vaccines. Alongside "treatment as prevention" (TasP), which emphasizes testing and treating people living with HIV to maintain undetectable viral loads, PrEP has been demonstrated to be an important population-level strategy for eliminating new HIV infections in Canada (Lima et al, 2021). It is an essential part of UNAIDS (2022) strategy to meet its targets of reducing HIV acquisition globally.…”

mentioning

confidence: 99%

HIV pre-exposure prophylaxis (PrEP) should be free across Canada to those meeting evidence-based guidelines

Gaspar

Tan

Lachowsky

et al. 2022

The Canadian Journal of Human Sexuality

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HIV pre-exposure prophylaxis (PrEP) should be free across Canada for all those who meet evidence-based guidelines. PrEP is a highly effective tool for preventing HIV acquisition that has been approved for use in Canada since 2016. However, without public drug plans or private insurance, generic PrEP costs approximately $200 to $250 CAD monthly. Current PrEP programs across Canada are a confusing patchwork system with variability in coverage and prohibitive co-payments, making PrEP too expensive for many equity-deserving groups. However, publicly funded PrEP programs are demonstrated to be cost-effective and even cost-saving by reducing the long-term healthcare expenditures associated with managing HIV. PrEP is not just an individual-level clinical tool. It is a public health intervention. Alongside “treatment as prevention,” PrEP is an important population-level strategy for eliminating new HIV infections in Canada and can play a role in helping to address complex health inequities affecting communities highly affected by HIV. Navigating drug coverage for patients consumes time and resources among healthcare providers that could be spent helping to improve other social determinants of health. Affordability will remain the foremost barrier to PrEP access until PrEP is made free to all those who meet evidence-based guidelines.

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Can the combination of TasP and PrEP eliminate HIV among MSM in British Columbia, Canada?

Cited by 8 publications

References 45 publications

Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study

Phylogenetic prioritization of HIV-1 transmission clusters with viral lineage-level diversification rates

HIV pre-exposure prophylaxis (PrEP) should be free across Canada to those meeting evidence-based guidelines

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