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J Adolesc Health. 2018 Mar;62(3):311-319. doi: 10.1016/j.jadohealth.2017.09.023. Epub 2017 Dec 13.

Targeting Human Immunodeficiency Virus Pre-Exposure Prophylaxis to Adolescent Sexual Minority Males in Higher Prevalence Areas of the United States: A Modeling Study.

Author information

1
Department of Anthropology, University of Washington, Seattle, Washington; Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington. Electronic address: goodreau@uw.edu.
2
Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington.
3
Department of Epidemiology, Emory University, Atlanta, Georgia.
4
Department of Epidemiology, Emory University, Atlanta, Georgia; Department of Global Health, Emory University, Atlanta, Georgia.
5
Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
6
Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York.

Abstract

PURPOSE:

Pre-exposure prophylaxis (PrEP) is an effective and safe intervention to prevent human immunodeficiency virus (HIV) transmission in men who have sex with men; current Centers for Disease Control and Prevention guidelines indicate its use among high-risk adults. Adolescent sexual minority males (ASMM) also have significant HIV risk, but implementation strategies are likely to differ for this population. We aimed to estimate impact and efficiency of PrEP for ASMM in higher prevalence US settings, using a variety of implementation strategies and assumptions about coverage, adherence, and background prevalence.

METHODS:

We develop a stochastic, dynamic, network-based model, parametrized using numerous ASMM behavioral and clinical data sources. We simulate 10 years with and without PrEP, comparing percent of incident infections averted (impact) and number of person-years on PrEP per infection averted (efficiency).

RESULTS:

Our main scenario (PrEP for 16- to 18-year-old ASMM, initiating PrEP 6 months after first anal intercourse, 40% coverage, adherence profiles from the ATN 113 trial; 2.9% background HIV prevalence among ASMM) prevents 27.8% of infections, with 38 person-years on PrEP per infection averted. Expanding implementation to cover younger ages or earlier initiation has small effects on impact and efficiency. Targeting highest risk ASMM increases efficiency, but requires querying sexual histories. Across levels examined, coverage and adherence do not have major impacts on efficiency, whereas background prevalence does.

CONCLUSIONS:

PrEP can have a large impact on HIV incidence among ASMM in the United States, especially in settings with high prevalence. However, willingness of, and support for, providers will be central to achieving the coverage needed to make this a success.

KEYWORDS:

Adolescent sexual minority males; Bisexual males; HIV; Homosexual males; Mathematical modeling; Pre-exposure prophylaxis

PMID:
29248392
PMCID:
PMC5818296
[Available on 2019-03-01]
DOI:
10.1016/j.jadohealth.2017.09.023

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