Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
BMJ Open. 2019 Mar 4;9(3):e023453. doi: 10.1136/bmjopen-2018-023453.
(NG) and (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown.
An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study.
Baltimore City, Maryland, USA.
PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted).
The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year.
Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community.
Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.
（NG）和（CT）增加了男男性行为者（MSM）中 HIV 传播的风险。NG/CT 的诊断可能为通过提供暴露前预防（PrEP）来预防 HIV 提供了一个有效的切入点；然而，针对诊断出 NG/CT 的 MSM 提供 PrEP 的额外人群层面的影响尚不清楚。
基于人口普查数据、疾病监测报告和美国国家 HIV 行为监测研究，对 MSM 中 NG/CT 和 HIV 共同传播的基于代理的模拟模型进行了校准。
美国马里兰州巴尔的摩市。
根据三种替代方案，对 PrEP 的实施进行建模：（1）NG/CT 诊断时提供 PrEP（靶向性提供），（2）NG/CT 筛查/检测时评估 PrEP，（3）社区内评估 PrEP（非靶向性）。
在两种替代方案下，在 20 年的 PrEP 提供后，预计 HIV 的发病率：（1）每年为相同数量的 MSM 筛查 PrEP，或（2）每年为他们提供 PrEP。
假设 60%的使用率和 60%的依从率，将 PrEP 针对诊断出 NG/CT 的 MSM，可以将巴尔的摩市 MSM 中的 HIV 发病率在 20 年内降低 12.4%（95%不确定性范围（UR）为 10.3%至 14.4%），而不使用 PrEP。扩大 NG/CT 筛查的覆盖范围（使个体每年有 50%的机会接受 NG/CT 筛查，并在 NG/CT 诊断时评估 PrEP）可以进一步提高靶向 PrEP 的效果，从而在 20 年内将 HIV 发病率降低 22.0%（95%UR 为 20.1%至 23.9%）。与替代实施方案相比，在 NG/CT 诊断时评估 PrEP 将 PrEP 对 HIV 发病率的影响提高了 1.5 倍（95%UR 为 1.1 至 1.9），而在 NG/CT 筛查/检测时评估 PrEP 的情况下提高了 1.6 倍（95%UR 为 1.2 至 2.2），而在评估社区中随机 MSM 的情况下提高了 1.6 倍（95%UR 为 1.2 至 2.2）。
针对感染 NG/CT 的 MSM 提高了 PrEP 提供的效率和效果。如果能够在社区层面实现高水平的性传播感染筛查，那么 NG/CT 诊断可能是启动 PrEP 的一个非常有效的切入点。
