Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada.
J Acquir Immune Defic Syndr. 2021 Feb 1;86(2):e28-e42. doi: 10.1097/QAI.0000000000002535.
Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015-2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin.
Cotonou, Benin.
We developed a compartmental HIV transmission model featuring PrEP and antiretroviral therapy (ART) among the high-risk (FSW and clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared with TasP. We estimated the population-level impact of the 2-year study and several 20-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage [median, 2.5th-97.5th percentile uncertainty interval (95% UI)] of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP and 49% ART) scenarios.
The 2-year study (2017 coverages: 9% PrEP and 83% ART) prevented an estimated 8% (95% UI 6-12) and 6% (3-10) infections among FSW over 2 and 20 years, respectively, compared with 7% (3-11) and 5% (2-9) overall. The PrEP and TasP arms prevented 0.4% (0.2-0.8) and 4.6% (2.2-8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP and 88% ART) prevented 21% (17-26) and 17% (10-27) infections among FSW, respectively, and 5% (3-10) and 17% (10-27) overall. Compared with TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9× and 1.2× more infections among FSW and overall, respectively.
The demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages.
每日暴露前预防（PrEP）和治疗即预防（TasP）分别降低 HIV 获得和传播的风险。一项示范研究（2015-2017 年）评估了在贝宁科托努的性工作者（FSW）中 TasP 和 PrEP 的可行性。
贝宁科托努。
我们开发了一个包含 PrEP 和抗逆转录病毒疗法（ART）的 HIV 传播模型，适用于高风险人群（FSW 和客户）和低风险人群，根据历史流行病学和示范研究数据进行校准，反映了 PrEP 的使用率、依从性和保留率均低于 TasP。我们估计了为期 2 年的研究和几个 20 年干预方案的人群水平影响，独立和共同改变了覆盖率和依从性。我们报告了在干预和反事实（2017 年覆盖率：0%PrEP 和 49%ART）情景下，比较 HIV 感染预防的百分比[中位数，2.5%至 97.5%不确定区间（95%UI）]。
在为期 2 年的研究中（2017 年覆盖率：9%PrEP 和 83%ART），与 7%（3-11）和 5%（2-9）的总体情况相比，FSW 在 2 年和 20 年内分别估计减少了 8%（95%UI 6-12）和 6%（3-10）的感染。PrEP 和 TasP 组在 20 年内分别预防了 0.4%（0.2-0.8）和 4.6%（2.2-8.7）的感染。20 年 PrEP 和 TasP 扩大规模（2035 年覆盖率：47%PrEP 和 88%ART）分别预防了 FSW 中 21%（17-26）和 17%（10-27）的感染，以及总体上的 5%（3-10）和 17%（10-27）的感染。与 TasP 扩大规模单独相比，PrEP 和 TasP 联合扩大规模分别预防了 FSW 和总体上的 1.9 倍和 1.2 倍的感染。
示范研究的影响是适度的，主要来自 TasP。增加 PrEP 的依从性和覆盖率可显著提高 FSW 的预防效果，但总体效果很小。我们建议在预防方案中使用 TasP。
