Department of Epidemiology.
Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island.
AIDS. 2020 Aug 1;34(10):1509-1517. doi: 10.1097/QAD.0000000000002577.
It is unknown what levels of preexposure prophylaxis (PrEP) use are needed to reduce racial disparities in HIV incidence among men who have sex with men (MSM). Using an agent-based model, we quantified the impact of achieving PrEP coverage targets grounded in equity on racial disparities in HIV incidence among MSM in an urban setting in the Southeastern United States.
An agent-based model was adapted to simulate HIV transmission in a network of Black/African American and White MSM aged 18-39 years in the Atlanta-Sandy Springs-Roswell metropolitan area over 10 years (2015-2024). Scenarios simulated coverage levels consistent with targets based on the ratio of the number of individuals using PrEP to the number of individuals newly diagnosed in a calendar year (i.e., the 'PrEP-to-need ratio'), ranging from 1 to 10. Incidence rate ratios and differences were calculated as measures of disparities.
Without PrEP, the model predicted a rate ratio of 3.82 and a rate difference of 4.50 comparing HIV incidence in Black/African American and White MSM, respectively. Decreases in the rate ratio of at least 50% and in the rate difference of at least 75% were observed in all scenarios in which the PrEP-to-need ratio among Black/African American MSM was 10, regardless of the value among White MSM.
Significant increases in PrEP use are needed among Black/African American MSM to reduce racial disparities in HIV incidence. PrEP expansion must be coupled with structural interventions to address vulnerability to HIV infection among Black/African American MSM.
尚不清楚预防用药（PrEP）的使用水平需要达到多少，才能减少男男性行为者（MSM）中与HIV 发病率相关的种族差异。本研究采用基于主体的模型，量化了在美国东南部城市环境中，实现基于公平的 PrEP 覆盖率目标对 MSM 中 HIV 发病率种族差异的影响。
我们改编了一个基于主体的模型，以模拟在亚特兰大-桑迪斯普林斯-罗斯韦尔大都市区的 18-39 岁的黑人和白种 MSM 网络中 HIV 传播。该模型使用了在给定的日历年内使用 PrEP 的人数与新诊断出 HIV 的人数的比值（即“PrEP 需求比”）作为覆盖水平的目标，模拟了从 1 到 10 的 PrEP 覆盖率水平。发病率比和差异作为衡量差异的指标。
在没有 PrEP 的情况下，模型预测黑人和白种 MSM 的 HIV 发病率的发病率比为 3.82，差异率为 4.50。在所有情况下，只要黑种 MSM 的 PrEP 需求比达到 10，无论白种 MSM 的比值是多少，都可以观察到发病率比至少降低 50%和差异率至少降低 75%。
需要增加黑种 MSM 对 PrEP 的使用，以减少 HIV 发病率的种族差异。PrEP 的扩大必须与结构干预措施相结合，以解决黑种 MSM 中 HIV 感染的脆弱性问题。
