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Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore.

Methods: A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations.

Results: Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use.

Conclusions: PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.

No MeSH data available.


Related in: MedlinePlus

Percentage of infections averted in the whole Bangalore population.Percentage of infections averted in the whole Bangalore population over five and ten years, for an intervention with 50% adherence and 60% coverage of the priority group (as shown). Bar shows median and error bars are 95% credible interval across 115 parameter sets. Credible intervals give the 2.5th and 97.5th percentiles of estimates across all parameter combinations.
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Figure 0003: Percentage of infections averted in the whole Bangalore population.Percentage of infections averted in the whole Bangalore population over five and ten years, for an intervention with 50% adherence and 60% coverage of the priority group (as shown). Bar shows median and error bars are 95% credible interval across 115 parameter sets. Credible intervals give the 2.5th and 97.5th percentiles of estimates across all parameter combinations.

Mentions: The proportion of IA in the whole Bangalore population after five years was low, but greater with FSW prioritization (1.8% (0.9–3.1%), for 50% adherence and 60% coverage) than HR-MSM prioritization (1.2% (0.5–2.9%)). The proportion of IA when both groups were prioritized (2.9%) was almost additive (Figure 3). Impact increased by 50% after 10 years (4.3% prioritizing FSW + HR-MSM). Prioritizing only lower-condom FSWs gave substantially lower population-level impact (Figure 3). With FSW prioritization, large numbers of infections were prevented amongst FSWs, clients and other groups, whereas most infections were prevented amongst MSM with HR-MSM prioritization (Supplementary Figure 8).


Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study
Percentage of infections averted in the whole Bangalore population.Percentage of infections averted in the whole Bangalore population over five and ten years, for an intervention with 50% adherence and 60% coverage of the priority group (as shown). Bar shows median and error bars are 95% credible interval across 115 parameter sets. Credible intervals give the 2.5th and 97.5th percentiles of estimates across all parameter combinations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016494&req=5

Figure 0003: Percentage of infections averted in the whole Bangalore population.Percentage of infections averted in the whole Bangalore population over five and ten years, for an intervention with 50% adherence and 60% coverage of the priority group (as shown). Bar shows median and error bars are 95% credible interval across 115 parameter sets. Credible intervals give the 2.5th and 97.5th percentiles of estimates across all parameter combinations.
Mentions: The proportion of IA in the whole Bangalore population after five years was low, but greater with FSW prioritization (1.8% (0.9–3.1%), for 50% adherence and 60% coverage) than HR-MSM prioritization (1.2% (0.5–2.9%)). The proportion of IA when both groups were prioritized (2.9%) was almost additive (Figure 3). Impact increased by 50% after 10 years (4.3% prioritizing FSW + HR-MSM). Prioritizing only lower-condom FSWs gave substantially lower population-level impact (Figure 3). With FSW prioritization, large numbers of infections were prevented amongst FSWs, clients and other groups, whereas most infections were prevented amongst MSM with HR-MSM prioritization (Supplementary Figure 8).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore.

Methods: A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations.

Results: Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use.

Conclusions: PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.

No MeSH data available.


Related in: MedlinePlus