Format

Send to

Choose Destination
J Int AIDS Soc. 2016 Sep 7;19(1):20942. doi: 10.7448/IAS.19.1.20942. eCollection 2016.

Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study.

Author information

1
Social and Mathematical Epidemiology Group (SaME), London School of Hygiene and Tropical Medicine, London, UK.
2
Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Kate.Mitchell@imperial.ac.uk.
3
Karnataka Health Promotion Trust, Bangalore, India.
4
St John's Research Institute, Bangalore, India.
5
Center for Global Public Health (CGPH), University of Manitoba, Winnipeg, Canada.
6
CHARME-India Project, Bangalore, India.
7
Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
8
School of Social and Community Medicine, University of Bristol, Bristol, UK.

Abstract

INTRODUCTION:

In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore.

METHODS:

A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations.

RESULTS:

Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use.

CONCLUSIONS:

PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.

KEYWORDS:

focussed intervention; high-risk group; key population; oral PrEP; prevention; prioritizing; targeting

PMID:
27609782
PMCID:
PMC5016494
DOI:
10.7448/IAS.19.1.20942
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center