Division of Infectious Diseases, University of California, San Diego, La Jolla, California, United States of America.
Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Sci Rep. 2016 Jun 24;6:28707. doi: 10.1038/srep28707.
It remains unclear what proportions of HIV-infected and uninfected people should receive effective antiretroviral therapy (ART) to control local HIV epidemics. We developed a flexible model to evaluate the impact of treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) on HIV incidence in local communities. We evaluated this tool for determining what TasP and PrEP targets are needed to substantially reduce the HIV epidemic in San Diego, which is predominately comprised of men who have sex with men. By increasing the proportion of HIV-infected individuals on ART from 30% to 50%, 686 new infections would be prevented over five years in San Diego. By providing PrEP to 30% of MSM to the age group that account for 90% of local HIV incident cases (21-52 years), we could prevent 433 infections over five years. When combining these initiatives, a PrEP coverage rate of 40% and TasP coverage rate of 34% would be expected to decrease the number of new infections by over half in one year. This online tool is designed to help local public health planners and policy makers to estimate program outcomes and costs that may lead to better control of their local HIV epidemics.
目前尚不清楚应该让多大比例的 HIV 感染者和未感染者接受有效的抗逆转录病毒治疗（ART）以控制当地的 HIV 流行。我们开发了一个灵活的模型来评估治疗即预防（TasP）和暴露前预防（PrEP）对当地社区 HIV 发病率的影响。我们评估了这一工具，以确定在以男男性行为者为主的圣地亚哥，需要达到什么样的 TasP 和 PrEP 目标才能大幅减少 HIV 流行。将接受抗逆转录病毒治疗的 HIV 感染者比例从 30%提高到 50%，圣地亚哥将在五年内预防 686 例新感染。通过向占当地 HIV 发病病例 90%的年龄组（21-52 岁）的 30%的男男性行为者提供 PrEP，我们可以在五年内预防 433 例感染。如果将这些措施结合起来，预计 PrEP 覆盖率达到 40%，TasP 覆盖率达到 34%，将使一年的新感染人数减少一半以上。这个在线工具旨在帮助当地公共卫生规划者和决策者估计可能导致更好地控制当地 HIV 流行的项目结果和成本。
