Walker Michael L, Stiasny David, Guy Rebecca J, Law Matthew G, Holt Martin, Mao Limin, Donovan Basil, Grulich Andrew E, Gray Richard T, Regan David G
From the Kirby Institute, UNSW Sydney.
Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
Sex Transm Dis. 2022 Aug 1;49(8):534-540. doi: 10.1097/OLQ.0000000000001649. Epub 2022 May 24.
The rollout of preexposure prophylaxis (PrEP) for HIV prevention among gay and bisexual men (GBM) is associated with increases in condomless anal intercourse, potentially increasing the incidence of other sexually transmissible infections (STIs).
We developed an individual-based mathematical model to simulate the transmission of Neisseria gonorrhoeae among GBM in Sydney, accounting for changes in sexual practices, STI testing, and PrEP use. We calibrated and validated the model using reported incidence rates for HIV-positive and HIV-negative GBM from 2010 to 2019. Scenarios were run with varying PrEP uptake, PrEP-related STI testing, and PrEP-related sexual behavior and testing intervals up to 2030 to assess the impact of PrEP use on gonorrhea incidence.
Preexposure prophylaxis uptake and associated 3-monthly STI testing from 2015 onward resulted in a predicted increase from 20 to 37 N. gonorrhoeae infections per 100 person-years among HIV-negative GBM by the end of 2020. This is lower than the counterfactual predictions of 45 per 100 person-years if PrEP were not scaled up and 48 per 100 person-years with nonadherence to 3-monthly STI testing. Increasing the time between STI tests for PrEP users by 1 month from 2018 results in the incidence rate among HIV-negative GBM increasing by 8% by 2030. If PrEP coverage doubles from 24% to 53%, incidence among HIV-negative GBM declines by ~25% by 2030.
Behavior change due to widespread PrEP use may lead to significant increases in gonorrhea incidence in GBM, but the recommended quarterly STI testing recommended for PrEP users should reduce incidence by 18% by 2030.
在男同性恋者和双性恋男性（GBM）中推行用于预防艾滋病毒的暴露前预防（PrEP）与无保护肛交行为的增加有关，这可能会增加其他性传播感染（STIs）的发病率。
我们建立了一个基于个体的数学模型，以模拟悉尼GBM中淋病奈瑟菌的传播情况，该模型考虑了性行为的变化、性传播感染检测以及PrEP的使用情况。我们使用2010年至2019年报告的艾滋病毒阳性和阴性GBM的发病率对模型进行了校准和验证。运行不同PrEP使用率、与PrEP相关的性传播感染检测以及与PrEP相关的性行为和检测间隔的情景，直至2030年，以评估PrEP的使用对淋病发病率的影响。
从2015年起采用PrEP并进行相关的每三个月一次的性传播感染检测，预计到2020年底，艾滋病毒阴性GBM中每100人年的淋病奈瑟菌感染病例将从20例增加到37例。这低于如果不扩大PrEP使用规模时每100人年45例的反事实预测，以及不坚持每三个月进行一次性传播感染检测时每100人年48例的预测。从2018年起将PrEP使用者的性传播感染检测间隔时间延长1个月，到2030年艾滋病毒阴性GBM中的发病率将增加8%。如果PrEP覆盖率从24%翻倍至53%，到2030年艾滋病毒阴性GBM中的发病率将下降约25%。
广泛使用PrEP导致的行为改变可能会使GBM中的淋病发病率显著上升，但为PrEP使用者推荐的每季度性传播感染检测到2030年应可使发病率降低18%。
