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A mathematical model of biomedical interventions for HIV prevention among men who have sex with men in China

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      Abstract

      Background

      The new HIV treatment guidelines in China recommend antiretroviral therapy (ART) for all people living with HIV, but significant gaps in implementation still exist. Pre-exposure prophylaxis (PrEP) can effectively reduce the risk of HIV transmission among men who have sex with men (MSM). This study assessed the epidemiological impact and cost effectiveness of PrEP, enhanced biomedical interventions and their combination among MSM in China.

      Methods

      A deterministic mathematical model was developed and projected over 20 years to assess the impact of the PrEP, biomedical interventions and their combinations. Incidence and prevalence of HIV were measured, and cost-effectiveness was assessed using incremental cost (international dollars, Int.$) per quality-adjusted life year (QALY) gained.

      Results

      A total of 0.78 million new HIV infections were estimated to occur over the next 20 years if no additional interventions are implemented among MSM. The PrEP-only strategy covering 25–75% of HIV-negative high-risk MSM can prevent 0.09–0.20 million (12.1–25.7%) new infections, at a cost of 17,277–18,452 Int.$/QALY. The optimal cost-effectiveness path is from test-and-treat to the combination strategy of test-and-treat and PrEP. Some strategies could almost eliminate new HIV infections over the next 20 years.

      Conclusions

      PrEP, test-and-treat, and their combinations among MSM are effective and cost-effective relative to current policy. PrEP is an important and cost-effective addition to current policy in China.

      Electronic supplementary material

      The online version of this article (10.1186/s12879-018-3516-8) contains supplementary material, which is available to authorized users.

      Related collections

      Most cited references 31

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      Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.

      Antiretroviral chemoprophylaxis before exposure is a promising approach for the prevention of human immunodeficiency virus (HIV) acquisition. We randomly assigned 2499 HIV-seronegative men or transgender women who have sex with men to receive a combination of two oral antiretroviral drugs, emtricitabine and tenofovir disoproxil fumarate (FTC-TDF), or placebo once daily. All subjects received HIV testing, risk-reduction counseling, condoms, and management of sexually transmitted infections. The study subjects were followed for 3324 person-years (median, 1.2 years; maximum, 2.8 years). Of these subjects, 10 were found to have been infected with HIV at enrollment, and 100 became infected during follow-up (36 in the FTC-TDF group and 64 in the placebo group), indicating a 44% reduction in the incidence of HIV (95% confidence interval, 15 to 63; P=0.005). In the FTC-TDF group, the study drug was detected in 22 of 43 of seronegative subjects (51%) and in 3 of 34 HIV-infected subjects (9%) (P<0.001). Nausea was reported more frequently during the first 4 weeks in the FTC-TDF group than in the placebo group (P<0.001). The two groups had similar rates of serious adverse events (P=0.57). Oral FTC-TDF provided protection against the acquisition of HIV infection among the subjects. Detectable blood levels strongly correlated with the prophylactic effect. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT00458393.).
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        Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model.

        Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual. The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. It could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1.7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease. Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.
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          On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection.

          Antiretroviral preexposure prophylaxis has been shown to reduce the risk of human immunodeficiency virus type 1 (HIV-1) infection in some studies, but conflicting results have been reported among studies, probably due to challenges of adherence to a daily regimen.
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 2360 039X, GRID grid.12981.33, Department of Health Policy and Management & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, , Sun Yat-sen University, ; Guangzhou, China
            [2 ]ISNI 0000 0001 2360 039X, GRID grid.12981.33, Department of Health Policy and Management, School of Public Health, , Sun Yat-sen University, ; Guangzhou, China
            [3 ]ISNI 0000 0001 0318 6320, GRID grid.419588.9, Graduate School of Public Health, St. Luke’s International University, ; Tokyo, Japan
            [4 ]ISNI 0000 0001 2360 039X, GRID grid.12981.33, Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, , Sun Yat-sen University, ; Guangzhou, China
            [5 ]ISNI 0000 0000 8803 2373, GRID grid.198530.6, Division of Virology and Immunology, National Center for AIDS/STD Control and Prevention (NCAIDS), , Chinese Center for Disease Control and Prevention, ; Beijing, China
            [6 ]ISNI 0000 0001 2360 039X, GRID grid.12981.33, School of Public Health (Shenzhen), Sun Yat-sen University, ; Shenzhen, China
            [7 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, Kirby Institute, , University of New South Wales, ; Sydney, Australia
            [8 ]ISNI 0000 0004 1937 0482, GRID grid.10784.3a, The School of Public Health and Primary Care, , The Chinese University of Hong Kong, ; Hong Kong, China
            Contributors
            lijinghua3@mail.sysu.edu.cn
            penglp3@mail2.sysu.edu.cn
            ORCID: http://orcid.org/0000-0002-6556-0995, +81 355504101 , sgilmour@slcn.ac.jp
            gujing5@mail.sysu.edu.cn
            ruanyuhua92@163.com
            zouhuachun@mail.sysu.edu.cn
            haochun@mail.sysu.edu.cn
            haoyt@mail.sysu.edu.cn
            jlau@cuhk.edu.hk
            Journal
            BMC Infect Dis
            BMC Infect. Dis
            BMC Infectious Diseases
            BioMed Central (London )
            1471-2334
            28 November 2018
            28 November 2018
            2018
            : 18
            30486800 6263536 3516 10.1186/s12879-018-3516-8
            © The Author(s). 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
            Award ID: 81803334
            Award Recipient :
            Funded by: National Centre for Global Health and Medicine
            Award ID: 30A-1007
            Award Recipient :
            Categories
            Research Article
            Custom metadata
            © The Author(s) 2018

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