Likely impact of pre-exposure prophylaxis on HIV epidemics among men who have sex with men

Abstract

Abstract. Rapid developments in the field of HIV pre-exposure prophylaxis (PrEP) with antiretrovirals offer a promise to bring HIV transmission among gay and other men who have sex with men (MSM) to zero by 2030. This review evaluates studies, which modelled the impact of PrEP on HIV diagnoses, and discusses the progress towards PrEP implementation. Studies in English, conducted after 2010 among MSM in countries of the Organization for Economic Cooperation and Development (OECD) were reviewed. Six modelling studies were included, three of which had been conducted outside the US. None of the published models showed that PrEP alone can reduce HIV diagnoses to zero and eliminate HIV transmission by 2030. However, PrEP in combination with other biomedical interventions can reduce HIV diagnoses on the population level by~95%. Other upcoming biomedical prevention strategies may strengthen combination prevention. Access to PrEP remains limited, even in the OECD countries. Modelling studies can assist governments with decisionmaking about PrEP implementation and add urgency to the implementation of PrEP. More work is needed on modelling of the impact of PrEP on HIV diagnoses trends outside the US where PrEP implementation is in its early stages.

Use of an HIV‐risk screening tool to identify optimal candidates for PrEP scale‐up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk

“…Participant characteristics are described in Table 1. Median (interquartile range, IQR) age was 31 (26,38) years and most were white (55.2%), employed fulltime (69.7%) and had a college/undergraduate education or higher (88.5%). More than half of men had drug insurance coverage (69.6%) and a family doctor with whom they felt comfortable discussing their sexual health (55.5%).…”

“…Targeting PrEP to those at highest risk is important to limit its potential risks (side effects, toxicity, risk compensation) and maximize cost-effectiveness. Current guidelines recommend that PrEP be considered for those ''at substantial risk of HIV acquisition'' [12], but evidence-based guidance on how to conduct this assessment is scarce [26]. In this study, we applied a validated MSM-specific HIV risk screening tool to MSM seeking anonymous point-of-care HIV testing [16] and found that the majority (64.4%) met the recommended highrisk cut-off score of ]10.…”

HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988–2017

“…Four (3%) reviews focused on PrEP use to prevent HIV infection (Holt, 2014;Kojima, Davey, & Klausner, 2016;Scholl, 2016;Zablotska, 2016); mean quality was low. One was a meta-analysis (Kojima et al, 2016).…”

“…For example, although the meta-analysis reported an increase in STIs among MSM taking PrEP (Kojima et al, 2016), this finding was later questioned because of concerns regarding data analysis (Harawa et al, 2017;Kojima et al, 2016). Another review concluded that PrEP alone cannot reduce HIV diagnoses to zero and thus eliminate HIV transmission by the year 2030 (Zablotska, 2016). Finally, PrEP access may also be limited because of barriers such as stigma and low awareness of PrEP (Holt, 2014;Scholl, 2016).…”

2020, sexually transmissible infections and HIV in gay, bisexual and other men who have sex with men

“…10 To date, most population-level effectiveness has come from models that indicate that universal uptake of PrEP by all GBM could result in 50–60% fewer infections in the next 10 years. 10 However, achieving this would be expensive, estimated at approximately US$1.6 million per one infection averted. 18 A targeted approach with uptake of PrEP by high-risk GBM could achieve a similar result but at lower cost.…”