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Epidemiol Infect. 2018 Jun;146(8):1015-1025. doi: 10.1017/S0950268818000845. Epub 2018 Apr 15.

HIV prevention strategies and risk of infection: a model-based analysis.

Author information

1
Institute for Microbiology,Charité - University Medicine Berlin,Berlin,Germany.
2
Department of Microbiology and Hospital Hygiene,Bundeswehr Hospital Hamburg,Hamburg,Germany.
3
Institute for Medical Microbiology,Virology and Hygiene,University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
4
Institute for Hygiene and Environment,City of Hamburg,Hamburg,Germany.
5
Institute for Experimental Gene Therapy and Cancer Research,University Medicine Rostock,Rostock,Germany.
6
Duy Tan University,Đà Nẵng,Vietnam.
7
Infectious Disease Epidemiology,Bernhard Nocht Institute for Tropical Medicine Hamburg,Hamburg,Germany.

Abstract

Risk populations for HIV infections tend to neglect condom use, making alternative preventive approaches necessary. Accordingly, we modelled the risk of sexual HIV transmission for condom use vs. use of rapid diagnostic test (RDT) systems with subsequent exclusion of potential sexual partners with a correctly or falsely positive test from unprotected sex with and without the use of HIV pre-exposure prophylaxis (PrEP) in a bio-statistical approach. We combined a previously described model of transmission risk for HIV-exposed individuals with a newly suggested model of risk of HIV exposure for sexually active HIV-negative individuals. The model was adapted for several stages of infection and different strategies of HIV infection prevention.HIV prevention with RDTs can reduce the transmission risk by up to 97% compared with having sex without any prevention and up to 80% compared with condom use. Nevertheless, RDT-based prevention strategies demonstrate a lack of protection in several stages of infection; in particular, RNA-based RDT systems may fail under treatment. RDT-based pre-screening of potential sex partners prior to unprotected sexual contacts substantially reduces HIV transmission risk. Combination of different prevention strategies is advisable for high-risk groups.

KEYWORDS:

Condoms; HIV transmission risk; epidemiology; modelling; pre-expositional prophylaxis; rapid diagnostic tests

PMID:
29655384
DOI:
10.1017/S0950268818000845
[Indexed for MEDLINE]

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