Test-and-Treat in Los Angeles: A Mathematical Model of the Effects of Test-and-Treat for the Population of Men Who Have Sex With Men in Los Angeles County

Sood, Neeraj; Wagner, Zachary; Jaycocks, Amber; Drabo, Emmanuel Fulgence; Vardavas, Raffaele

doi:10.1093/cid/cit158

Cited by 44 publications

(40 citation statements)

References 21 publications

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“…Of particular importance are local genital tract inflammatory processes that increase HIV shedding in semen rendering an individual more infectious than is apparent from his blood plasma viral load (Kalichman, Diberto, & Eaton, 2008;Pilcher et al, 2006). Thus, increases in condomless anal sex and exposure to STI will ultimately diminish the prevention benefits of HIV treatments (Jansen, Schmidt, Drewes, Bremer, & Marcus, 2016;Katz, Dombrowski, Bell, Kerani, & Golden, 2016;Payne, Lawrence, Soni, Llewellyn, & Dean, 2016;Sood, Wagner, Jaycocks, Drabo, & Vardavas, 2013). …”

Section: Discussionmentioning

confidence: 99%

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

et al. 2017

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Community-wide awareness that ART provides protection against HIV has the potential to increase perceived safety and thereby increase condomless anal sex among men who have sex with men (MSM). Furthermore, reductions in condom use can increase exposure to sexually transmitted infections, which in turn can reduce the protective effects of ART on HIV transmission. The current study extends previous community-based behavioral surveillance research on beliefs regarding use of ART for HIV prevention and sexual practices among MSM. Anonymous cross-sectional community surveys were collected from 1831 men at the same Gay pride event in Atlanta, GA four times over nearly two decades; 1997, 2005–2006 (the 2006 survey over-sampled African Americans to diversify the study), and 2015. Results indicate clear and consistent trends of increasing beliefs that HIV treatments reduce HIV transmission risks, reflecting the dissemination of HIV prevention research findings. Changes in treatment beliefs coincide with increased rates of condomless anal intercourse. Increased beliefs that treatments prevent HIV and increased condomless anal sex were observed for both HIV positive men and men who had not tested HIV positive. Results illustrate the emergence of an era where ART is the focus of HIV prevention and community-held beliefs and behaviors regarding definitions of risk create a new and potentially problematic environment for HIV transmission.

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Section: Discussionmentioning

confidence: 99%

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

et al. 2017

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“…(13) Neeraj Sood and colleagues and Rochelle Walensky and colleagues modeled the effects of test-and-treat approaches in Los Angeles and Washington, D.C., respectively, and found [please briefly explain their findings]. (14,15)…”

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confidence: 99%

Early HIV Treatment In The United States Prevented Nearly 13,500 Infections Per Year During 1996–2009

et al. 2014

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In recent years, guidelines for HIV treatment have recommended initiation of combination antiretroviral therapy (cART) earlier in the course of the disease than was previously the case. These recommendations stem in part from growing evidence that treatment reduces the risk of sexual transmission. We used an epidemiological model of disease transmission and progression to assess HIV prevention through early treatment—that is, initiation of cART when CD4 white blood cell counts are in excess of 350 cells/mm3.(CD4 cells are involved in the immune system’s defense against tumors and infection; the number of CD4 cells in a cubic millimeter of blood is a standard measure of immune response to antiretroviral therapy.) We estimated that the actual timing of treatment initiation in the United States prevented 188,000 HIV cases in the period 1996-2009. “Very early” treatment (at CD4 counts greater than 500 cells/mm3) accounted for one-fifth of the prevented cases. For all of the prevented cases, the losses in life expectancy that were avoided were worth $128 billion, assuming that a life-year has a value of $150,000. These findings underscore the cost-effectiveness of early HIV treatment.

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“…Modelling studies have explored the widespread use of ART but mainly in sub-Saharan settings [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89], in the United States [90;91], in China [92][93][94], Canada [95] and for some specific groups, such as MSM in Australia [36;96;97], in Peru, Ukraine, Kenya and Thailand [98] and in different cities in the United States [99][100][101][102][103]; only a few of them model the HIV epidemic in European countries (MSM in Amsterdam, the Netherlands [104] and in the UK [105][106][107] and people who inject drugs in Russia [108]). They varied in their conclusions, although most have suggested potential appreciable beneficial effects on HIV incidence of introducing ART initiation at a higher CD4 count as a policy at a population level.…”

Section: European Population-level Impactmentioning

confidence: 99%

Antiretroviral therapy for prevention of HIV transmission: implications for Europe

et al. 2013

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The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm 3 . The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm 3 . The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

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Test-and-Treat in Los Angeles: A Mathematical Model of the Effects of Test-and-Treat for the Population of Men Who Have Sex With Men in Los Angeles County

Abstract: Although test-and-treat generates substantial benefits, it will not eliminate the epidemic for MSM in LAC. Moreover, these benefits are counterbalanced by large increases in MDR.

Cited by 44 publications

References 21 publications

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

Diminishing Perceived Threat of AIDS and Increasing Sexual Risks of HIV Among Men Who Have Sex with Men, 1997–2015

Early HIV Treatment In The United States Prevented Nearly 13,500 Infections Per Year During 1996–2009

Antiretroviral therapy for prevention of HIV transmission: implications for Europe

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