Reitsema Maarten, Wallinga Jacco, van Sighem Ard I, Bezemer Daniela, van der Valk Marc, van Aar Fleur, Heijne Janneke Cornelia Maria, Hoornenborg Elske, Rozhnova Ganna, van Benthem Birgit, Xiridou Maria
Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands.
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
J Acquir Immune Defic Syndr. 2024 Dec 1;97(4):325-333. doi: 10.1097/QAI.0000000000003511.
In 2019, a 5-year pre-exposure prophylaxis (PrEP) program started in the Netherlands, in which up to 8500 men who have sex with men (MSM) can obtain PrEP and 3-monthly consultations with HIV/STI testing.
We assessed the impact of the PrEP program on transmission of HIV and Neisseria gonorrhea (NG) among MSM in the Netherlands and examined prospective variations of the program after 2024.
We used an agent-based model to estimate the effect of the PrEP program. For hypothetical prospective PrEP programs starting in 2024, we varied the capacity (8,500; 12,000; 16,000 participants) and consultation frequency (3-monthly; 6-monthly; 70% 3-monthly and 30% 6-monthly).
At a capacity of 8,500 participants and 3-monthly consultations, the PrEP program could lead to 3,140 [95% credible interval (95% CrI): 1,780-4,780] and 27,930 (95% CrI: 14,560-46,280) averted HIV and NG infections, requiring 316,050 (95% CrI: 314,120-317,580) consultations. At a capacity of 16,000 participants, the programs with 3-monthly consultations and 6-monthly consultations could lead to comparable number of averted HIV [3,940 (95% CrI: 2,420-5,460), and 3,900 (2,320-5,630) respectively] and NG infections [29,970 (95% CrI: 15,490-50,350), and 29,960 (95% CrI: 13,610-50,620) respectively], while requiring substantially different number of consultations: 589,330 (95% CrI: 586,240-591,160) and 272,590 (95% CrI: 271,770-273,290), respectively.
Continuation of a PrEP program could lead to a substantial reduction in HIV and NG transmission. More infections could be averted if the number of participants is increased. In turn, the consultation frequency could be reduced without reducing the number of averted infections if capacity is increased.
2019年，荷兰启动了一项为期5年的暴露前预防（PrEP）项目，该项目中多达8500名男男性行为者（MSM）可获得PrEP并每3个月接受一次HIV/性传播感染检测咨询。
我们评估了PrEP项目对荷兰男男性行为者中HIV和淋病奈瑟菌（NG）传播的影响，并研究了2024年后该项目的预期变化。
我们使用基于主体的模型来估计PrEP项目的效果。对于假设的2024年开始的前瞻性PrEP项目，我们改变了参与能力（8500人；12000人；16000人）和咨询频率（每3个月一次；每6个月一次；70%每3个月一次和30%每6个月一次）。
在参与能力为8500人且每3个月进行一次咨询的情况下，PrEP项目可避免3140例[95%可信区间（95%CrI）：1780 - 4780]HIV感染和27930例（95%CrI：14560 - 46280）NG感染，需要316050次（95%CrI：314120 - 317580）咨询。在参与能力为16000人的情况下，每3个月进行一次咨询和每6个月进行一次咨询的项目可避免的HIV感染数量相当[分别为3940例（95%CrI：2420 - 5460）和3900例（2320 - 5630）]，NG感染数量也相当[分别为29970例（95%CrI：15490 - 50350）和29960例（95%CrI：13610 - 50620）]，但所需咨询次数差异很大：分别为589330次（95%CrI：586240 - 591160）和272590次（95%CrI：271770 - 273290）。
继续实施PrEP项目可大幅减少HIV和NG的传播。增加参与者数量可避免更多感染。反过来，如果增加参与能力，在不减少避免感染数量的情况下可以降低咨询频率。
