Expanded antiretroviral treatment, sexual networks, and condom use: Treatment as prevention unlikely to succeed without partner reduction among men who have sex with men in China

Abstract

BackgroundTo project the impact of partner reduction on preventing new HIV infections among men who have sex with men (MSM) under varying conditions of enhanced HIV testing and treatment (T&T) and condom use in Beijing, China.Methods and findingsA complex network model was fitted to predict the number of new HIV infections averted from 2014 to 2023 under four scenarios of sexual behavior risk reduction (S)—S1: Male sexual partners decrease (reduced by a random value m from 1–50) while condom use increases (risk constant p is a random value between 0.2 and 1]); S2: Both sexual partners and condom use decrease (m 1, 50; p 1, 1.8); S3: Sexual partners reduce (m 1, 10) while condom use increases or decreases (p 0.2, 1.8); S4: Only MSM with ≥100 male sexual partners reduce their partners (m 1, 50) while condom use increases (p 0.2, 1).HIV prevalence will reach 23.2% by 2023 among Beijing MSM if T&T remains at the 2013 level. The three most influential factors are: T&T coverage; partner reduction (m); and the background risk (p). Under scenarios 1–4 of sexual behavioral changes with enhanced T&T interventions, the cumulative HIV new infections prevented over the 10 years will be 46.8% for S1 (interquartile range [IQR] 32.4%, 60.1%); 29.7% for S2 (IQR 18.0%, 41.4%), 23.2% for S3 (IQR 12.2%, 37.0%) and 11.6% for S4 (IQR 4.0%, 26.6%), respectively. The reproduction number R0 could drop below 1 if there were a substantial reduction of male sexual partners and/or expanded condom use.ConclusionPartner reduction is a vital factor within HIV combination interventions to reduce HIV incidence among Beijing MSM, with substantial additional benefits derived from condom use. T&T without substantial partner reduction and increased condom use is less promising unless its implementation were extremely (and improbably) efficient.

Assessing Direct and Spillover Effects of Intervention Packages in Network-randomized Studies

“…48 Potential impact of a number of other HIV prevention strategies could be informed by estimating spillover effects in a community or social network. 49–51…”

“…48 Potential impact of a number of other HIV prevention strategies could be informed by estimating spillover effects in a community or social network. [49][50][51] The assumption of no unmeasured covariates associated with the network-level exposure and outcome is untestable. Future work could develop methods to assess the sensitivity of these methods to unmeasured confounders.…”

Assessing Direct and Spillover Effects of Intervention Packages in Network-Randomized Studies

“…As in vaccine campaign design, this could inform the level of ART coverage needed to benefit the community and consistently achieve targets such as the UNAIDS 2025 [48]. Potential impact of a number of other HIV prevention strategies could be informed by estimating spillover effects in the community or social network [49][50][51].…”

Protecting Men Who Have Sex With Men From HIV Infection With an mHealth App for Partner Notification: Observational Study

“…3. Allow users to query their HIV test results (ie, HIV status) conveniently and in a timely manner. 4. Protect users' privacy information in an effective, ethical, and nonobtrusive way.…”

“…Of the newly reported infections, 95.1% of people were infected through sexual transmission; 25.5% of them were men who have sex with men (MSM) and were infected though male-male sexual behaviors [3]. To control the spread of HIV effectively, providing antiretroviral therapy to people living with HIV/AIDS is a recommended method and is called treatment as prevention [4]. At present, antiretroviral therapy has covered about 75% of the reported HIV/AIDS cases worldwide and 80% of those in China, of which more than 90% were treated successfully [5,6].…”