Limits...
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

PrEP impact and efficiency in the whole population for different FSW prioritization scenarios.(a) % infections averted in the whole population after five years and (b) PrEP efficiency (life-years gained per 100 person-years on PrEP) measured in the whole population over 20 years, for the same total number of person-years on PrEP for different FSW prioritization scenarios. Bars show median and error bars are 95% credible interval across 115 parameter sets.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5016494&req=5

Figure 0005: PrEP impact and efficiency in the whole population for different FSW prioritization scenarios.(a) % infections averted in the whole population after five years and (b) PrEP efficiency (life-years gained per 100 person-years on PrEP) measured in the whole population over 20 years, for the same total number of person-years on PrEP for different FSW prioritization scenarios. Bars show median and error bars are 95% credible interval across 115 parameter sets.

Mentions: The proportion of IA and PrEP efficiency were roughly halved when the same amount of PrEP was distributed amongst all FSWs or high-condom FSWs, compared with low-condom FSWs (Figure 5).


Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study
PrEP impact and efficiency in the whole population for different FSW prioritization scenarios.(a) % infections averted in the whole population after five years and (b) PrEP efficiency (life-years gained per 100 person-years on PrEP) measured in the whole population over 20 years, for the same total number of person-years on PrEP for different FSW prioritization scenarios. Bars show median and error bars are 95% credible interval across 115 parameter sets.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0005: PrEP impact and efficiency in the whole population for different FSW prioritization scenarios.(a) % infections averted in the whole population after five years and (b) PrEP efficiency (life-years gained per 100 person-years on PrEP) measured in the whole population over 20 years, for the same total number of person-years on PrEP for different FSW prioritization scenarios. Bars show median and error bars are 95% credible interval across 115 parameter sets.
Mentions: The proportion of IA and PrEP efficiency were roughly halved when the same amount of PrEP was distributed amongst all FSWs or high-condom FSWs, compared with low-condom FSWs (Figure 5).

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