Université de Paris, Infection Antimicrobien Modelisation Evolution, INSERM, Paris, France.
Unité des Maladies Emergentes, Institut Pasteur, Paris, France.
J Infect Dis. 2022 Mar 15;225(6):1032-1039. doi: 10.1093/infdis/jiaa633.
In Western Kenya up to one-quarter of the adult population was human immunodeficiency virus (HIV)-infected in 2012. The Ministry of Health, Médecins Sans Frontières, and partners implemented an HIV program that surpassed the 90-90-90 UNAIDS targets. In this generalized epidemic, we compared the effectiveness of preexposure prophylaxis (PrEP) with improving continuum of care.
We developed a dynamic microsimulation model to project HIV incidence and infections averted to 2030. We modeled 3 strategies compared to a 90-90-90 continuum of care base case: (1) scaling up the continuum of care to 95-95-95, (2) PrEP targeting young adults with 10% coverage, and (3) scaling up to 95-95-95 and PrEP combined.
In the base case, by 2030 HIV incidence was 0.37/100 person-years. Improving continuum levels to 95-95-95 averted 21.5% of infections, PrEP averted 8.0%, and combining 95-95-95 and PrEP averted 31.8%. Sensitivity analysis showed that PrEP coverage had to exceed 20% to avert as many infections as reaching 95-95-95.
In a generalized HIV epidemic with continuum of care levels at 90-90-90, improving the continuum to 95-95-95 is more effective than providing PrEP. Continued improvement in the continuum of care will have the greatest impact on decreasing new HIV infections.
2012 年，在肯尼亚西部，多达四分之一的成年人感染了人类免疫缺陷病毒（HIV）。卫生部、无国界医生组织及其合作伙伴实施了一项艾滋病毒规划，该规划超过了 90-90-90 艾滋病规划署目标。在这种普遍流行的情况下，我们比较了暴露前预防（PrEP）和改善护理连续性的效果。
我们开发了一个动态微观模拟模型，以预测到 2030 年 HIV 发病率和可预防感染。我们对 3 种策略与 90-90-90 护理连续性基本情况进行了建模比较：（1）将护理连续性扩大到 95-95-95，（2）针对年轻人进行 10%覆盖的 PrEP，以及（3）扩大到 95-95-95 并结合 PrEP。
在基本情况下，到 2030 年，HIV 发病率为 0.37/100 人年。将连续性水平提高到 95-95-95 可预防 21.5%的感染，PrEP 可预防 8.0%，将 95-95-95 和 PrEP 结合可预防 31.8%。敏感性分析表明，PrEP 覆盖率必须超过 20%，才能预防与达到 95-95-95 相同数量的感染。
在护理连续性水平达到 90-90-90 的普遍 HIV 流行中，将连续性提高到 95-95-95 比提供 PrEP 更有效。继续改善连续性护理将对减少新的 HIV 感染产生最大影响。
