Department of Epidemiology and Biostatistics, Dornsife School of Public Health, 582373Drexel University, Philadelphia, PA, USA.
Int J STD AIDS. 2022 Jan;33(1):18-30. doi: 10.1177/09564624211042444. Epub 2021 Sep 26.
Doxycycline post-exposure prophylaxis (PEP) holds the potential to mitigate increasing rates of syphilis among sexual minority men (SMM) in the US yet has received limited attention. Since evaluation of this intervention in actual populations is not currently feasible, we used agent-based models (ABM) to assess the population-level impact of this strategy. We adapted ABM of HIV and HPV transmission, representing a population of 10,230 SMM in Philadelphia, Pennsylvania, US. Parameter inputs were derived from the literature, and ABM outputs during the pre-intervention period were calibrated to local surveillance data. Intervention scenarios varied doxycycline uptake by 20, 40, 60, 80 and 100%, while assuming continued condom use and syphilis screening and treatment. Under each intervention scenario, we incorporated treatment adherence at the following levels: 0, 20, 40, 60, 80 and 100%. Long-term population impact of prophylactic doxycycline was measured using the cumulative incidence over the 10-year period and the percentage of infections prevented attributable to doxycycline at year 10. An uptake scenario of 20% with an adherence level of 80% would reduce the cumulative incidence of infections by 10% over the next decade, translating to 57 fewer cases per 1000 SMM. At year 10, under the same uptake and adherence level, 22% of infections would be prevented due to doxycycline PEP in the instances where condoms were not used or failed. Findings suggest that doxycycline PEP will have a modest impact on syphilis incidence when assuming a reasonable level of uptake and adherence. Doxycycline PEP may be most appropriate as a secondary prevention measure to condoms and enhanced syphilis screening for reducing infections among SMM.
多西环素暴露后预防（PEP）有可能降低美国性少数群体男性（SMM）中梅毒发病率的上升，但目前对此干预措施的关注有限。由于目前在实际人群中评估这种干预措施是不可行的，我们使用基于主体的模型（ABM）来评估这种策略对人群水平的影响。我们对 HIV 和 HPV 传播的 ABM 进行了改编，代表了美国宾夕法尼亚州费城的 10230 名 SMM 人群。参数输入来自文献，干预前期间的 ABM 输出与当地监测数据进行了校准。干预方案将多西环素的吸收率提高了 20%、40%、60%、80%和 100%，同时假设继续使用避孕套和梅毒筛查和治疗。在每种干预方案下，我们纳入了以下治疗依从性水平：0、20、40、60、80 和 100%。使用 10 年内累积发病率和第 10 年归因于多西环素预防的感染百分比来衡量预防性多西环素的长期人群影响。吸收率为 20%、依从性水平为 80%的方案在未来十年内可将感染的累积发病率降低 10%，相当于每 1000 名 SMM 减少 57 例病例。在相同的吸收率和依从性水平下，在未使用或避孕套失败的情况下，第 10 年，22%的感染将归因于多西环素 PEP。研究结果表明，假设多西环素 PEP 的吸收率和依从性合理，它将对梅毒发病率产生适度影响。多西环素 PEP 可能最适合作为减少 SMM 感染的避孕套和增强梅毒筛查的二级预防措施。
