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. 2018 Nov 13;32(17):2615-2623.
doi: 10.1097/QAD.0000000000002050.

Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Ganna Rozhnova  1 , Janneke Heijne  2 , Daniela Bezemer  3 , Ard van Sighem  3 , Anne Presanis  4 , Daniela De Angelis  4 , Mirjam Kretzschmar  1   2
Affiliations

Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Ganna Rozhnova et al. AIDS. .

Abstract

Objective: Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination.

Design and methods: We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use.

Results: At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%.

Conclusion: PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.

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Figures

Fig. 1
Fig. 1
Impact of preexposure prophylaxis uptake in the highest risk group.
Fig. 2
Fig. 2
Impact of preexposure prophylaxis uptake in two groups with highest risk.
Fig. 3
Fig. 3
Impact of antiretroviral treatment uptake if preexposure prophylaxis is unavailable.
Fig. 4
Fig. 4
Impact of increasing antiretroviral treatment levels in the entire population and preexposure prophylaxis uptake in the highest risk group.
Fig. 5
Fig. 5
Impact of preexposure prophylaxis effectiveness and duration of taking preexposure prophylaxis in the highest risk group.
See this image and copyright information in PMC

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