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Lancet HIV. 2018 Sep;5(9):e498-e505. doi: 10.1016/S2352-3018(18)30097-3. Epub 2018 Jun 13.

Potential effectiveness of long-acting injectable pre-exposure prophylaxis for HIV prevention in men who have sex with men: a modelling study.

Author information

1
Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. Electronic address: brandon_marshall@brown.edu.
2
Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
3
Department of Applied Mathematics, Brown University, Providence, RI, USA.
4
Center for Infectious Disease Modeling and Analysis, School of Public Health, Yale University, New Haven, CT, USA.
5
Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
6
Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.
7
Center for Infectious Disease Modeling and Analysis, School of Public Health, Yale University, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.

Abstract

BACKGROUND:

Oral pre-exposure prophylaxis (PrEP) prevents HIV infection in men who have sex with men (MSM); however, adherence is an ongoing concern. Long-acting injectable PrEP is being tested in phase 3 trials and could address challenges associated with adherence. We examined the potential effectiveness of long-acting injectable PrEP compared with oral PrEP in MSM.

METHODS:

We used an agent-based model to simulate HIV transmission in a dynamic network of 11 245 MSM in Atlanta, GA, USA. We used raw data from studies in macaque models and pharmacokinetic data from safety trials to estimate the time-varying efficacy of long-acting injectable PrEP. The effect of long-acting injectable PrEP on the cumulative number of new HIV infections over 10 years (2015-24) was compared with no PrEP and daily oral PrEP across a range of coverage levels. Sensitivity analyses were done with varying maximum efficacy and drug half-life values.

FINDINGS:

In the absence of PrEP, the model predicted 2374 new HIV infections (95% simulation interval [SI] 2345-2412) between 2015 and 2024. The cumulative number of new HIV infections was reduced in all scenarios in which MSM received long-acting injectable PrEP compared with oral PrEP. At a coverage level of 35%, compared with no PrEP, long-acting injectable PrEP led to a 44% reduction in new HIV infections (1044 new infections averted [95% SI 1018-1077]) versus 33% (792 infections averted [763-821]) for oral PrEP. The relative benefit of long-acting injectable PrEP was sensitive to the assumed efficacy of injections received every 8 weeks, discontinuation rates, and terminal drug half-life.

INTERPRETATION:

Long-acting injectable PrEP has the potential to produce larger reductions in HIV transmission in MSM than oral PrEP. However, the real-world, population-level impact of this approach will depend on uptake of this prevention method and its effectiveness, as well as retention of patients in clinical care.

FUNDING:

National Institute on Drug Abuse and National Institute of Mental Health.

PMID:
29908917
PMCID:
PMC6138558
[Available on 2019-09-01]
DOI:
10.1016/S2352-3018(18)30097-3

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