在三个资源丰富的地区为男男性行为者提供长效注射型 PrEP 以扩大 PrEP 覆盖面的人群影响：模型比较分析。

INTRODUCTION: Long-acting injectable cabotegravir (CAB-LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) in the HPTN 083/084 trials. We compared the potential impact of expanding PrEP coverage by offering CAB-LA to men who have sex with men (MSM) in Atlanta (US), Montreal (Canada) and the Netherlands, settings with different HIV epidemics. METHODS: Three risk-stratified HIV transmission models were independently parameterized and calibrated to local data. In Atlanta, Montreal and the Netherlands, the models, respectively, estimated mean TDF/FTC coverage starting at 29%, 7% and 4% in 2022, and projected HIV incidence per 100 person-years (PY), respectively, decreasing from 2.06 to 1.62, 0.08 to 0.03 and 0.07 to 0.001 by 2042. Expansion of PrEP coverage was simulated by recruiting new CAB-LA users and by switching different proportions of TDF/FTC users to CAB-LA. Population effectiveness and efficiency of PrEP expansions were evaluated over 20 years in comparison to baseline scenarios with TDF/FTC only. RESULTS: Increasing PrEP coverage by 11 percentage points (pp) from 29% to 40% by 2032 was expected to avert a median 36% of new HIV acquisitions in Atlanta. Substantially larger increases (by 33 or 26 pp) in PrEP coverage (to 40% or 30%) were needed to achieve comparable reductions in Montreal and the Netherlands, respectively. A median 17 additional PYs on PrEP were needed to prevent one acquisition in Atlanta with 40% PrEP coverage, compared to 1000+ in Montreal and 4000+ in the Netherlands. Reaching 50% PrEP coverage by 2032 by recruiting CAB-LA users among PrEP-eligible MSM could avert >45% of new HIV acquisitions in all settings. Achieving targeted coverage 5 years earlier increased the impact by 5-10 pp. In the Atlanta model, PrEP expansions achieving 40% and 50% coverage reduced differences in PrEP access between PrEP-indicated White and Black MSM from 23 to 9 pp and 4 pp, respectively. CONCLUSIONS: Achieving high PrEP coverage by offering CAB-LA can impact the HIV epidemic substantially if rolled out without delays. These PrEP expansions may be efficient in settings with high HIV incidence (like Atlanta) but not in settings with low HIV incidence (like Montreal and the Netherlands).

介绍：在 HPTN 083/084 试验中，长效注射用卡替拉韦（CAB-LA）在预防 HIV 暴露前（PrEP）方面优于每日替诺福韦二吡呋酯/恩曲他滨（TDF/FTC）。我们比较了通过向亚特兰大（美国）、蒙特利尔（加拿大）和荷兰的男男性行为者（MSM）提供 CAB-LA 来扩大 PrEP 覆盖范围的潜在影响，这些地区的 HIV 流行情况不同。

方法：三个风险分层的 HIV 传播模型分别进行了参数化和校准，以适应当地数据。在亚特兰大、蒙特利尔和荷兰，这些模型分别估计了 2022 年开始时 TDF/FTC 覆盖率分别为 29%、7%和 4%，并预测了每 100 人年（PY）的 HIV 发病率，分别从 2.06 降至 1.62、0.08 降至 0.03 和 0.07 降至 0.001。通过招募新的 CAB-LA 用户和将不同比例的 TDF/FTC 用户转换为 CAB-LA，模拟 PrEP 覆盖范围的扩大。与仅使用 TDF/FTC 的基线情景相比，在 20 年内评估了 PrEP 扩大的人群效果和效率。

结果：到 2032 年，将 PrEP 覆盖率从 29%提高到 40%增加 11 个百分点（pp），预计将使亚特兰大新感染 HIV 的比例降低中位数 36%。在蒙特利尔和荷兰，分别需要增加 33 或 26 个百分点（增加到 40%或 30%）的 PrEP 覆盖率，才能达到类似的减少。在亚特兰大，需要 17 个额外的 PrEP 暴露 PY 来预防一个人获得 40%的 PrEP 覆盖率，而在蒙特利尔和荷兰，则需要 1000 多个和 4000 多个。到 2032 年，通过在符合 PrEP 条件的 MSM 中招募 CAB-LA 用户，达到 50%的 PrEP 覆盖率，可以避免所有环境中超过 45%的新 HIV 感染。提前 5 年达到目标覆盖率，可将 PrEP 覆盖范围扩大 5-10 个百分点。在亚特兰大模型中，实现 40%和 50%覆盖率的 PrEP 扩大，将 PrEP 指示的白人和黑人 MSM 之间 PrEP 获得情况的差异从 23 个百分点减少到 9 个百分点和 4 个百分点。

结论：如果不延迟推出，通过提供 CAB-LA 来实现高 PrEP 覆盖率可以对 HIV 流行产生重大影响。这些 PrEP 扩大可能在 HIV 发病率高的地区（如亚特兰大）有效，但在 HIV 发病率低的地区（如蒙特利尔和荷兰）无效。