Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 1;33(12):1911-1922.
doi: 10.1097/QAD.0000000000002290.

A modeling framework to inform preexposure prophylaxis initiation and retention scale-up in the context of 'Getting to Zero' initiatives

Aditya S Khanna  1   2 , John A Schneider  1   2 , Nicholson Collier  3 , Jonathan Ozik  3 , Rodal Issema  1   2 , Angela di Paola  4 , Abigail Skwara  1   2 , Arthi Ramachandran  1   2 , Jeannette Webb  1   2 , Russell Brewer  1   2 , William Cunningham  5 , Charles Hilliard  6 , Santhoshini Ramani  1   2 , Kayo Fujimoto  4 , Nina Harawa  6   7 ; BARS Study Group and Getting to Zero IL Research Evaluation and Data (RED) Committee
Affiliations

A modeling framework to inform preexposure prophylaxis initiation and retention scale-up in the context of 'Getting to Zero' initiatives

Aditya S Khanna et al. AIDS. .

Abstract

Objective(s): 'Getting to Zero' (GTZ) initiatives aim to eliminate new HIV infections over a projected time frame. Increased preexposure prophylaxis (PrEP) uptake among populations with the highest HIV incidence, such as young Black MSM, is necessary to accomplish this aim. Agent-based network models (ABNMs) can help guide policymakers on strategies to increase PrEP uptake.

Design: Effective PrEP implementation requires a model that incorporates the dynamics of interventions and dynamic feedbacks across multiple levels including virus, host, behavior, networks, and population. ABNMs are a powerful tool to incorporate these processes.

Methods: An ABNM, designed for and parameterized using data for young Black MSM in Illinois, was used to compare the impact of PrEP initiation and retention interventions on HIV incidence after 10 years, consistent with GTZ timelines. Initiation interventions selected individuals in serodiscordant partnerships, or in critical sexual network positions, and compared with a controlled setting where PrEP initiators were randomly selected. Retention interventions increased the mean duration of PrEP use. A combination intervention modeled concurrent increases in PrEP initiation and retention.

Results: Selecting HIV-negative individuals for PrEP initiation in serodiscordant partnerships resulted in the largest HIV incidence declines, relative to other interventions. For a given PrEP uptake level, distributing effort between increasing PrEP initiation and retention in combination was approximately as effective as increasing only one exclusively.

Conclusion: Simulation results indicate that expanded PrEP interventions alone may not accomplish GTZ goals within a decade, and integrated scale-up of PrEP, antiretroviral therapy, and other interventions might be necessary.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:. Simulated annual mean incidence rates and PrEP uptake levels, under several intervention strategies to increase PrEP initiation (Panels A and B) to 30% while PrEP retention is held at base levels*, and increasing PrEP retention to a range of levels (Panels C and D), while PrEP initiation is held constant at base levels**.
* In the base case, PrEP retention is 12 months on average. ** In the base case, PrEP initiation is 12.7% of HIV-negatives for persons <=26 years old and 14.7% of HIV-negatives for persons > 26 years old.
Figure 2:
Figure 2:
Composition of steady state sexual network clusters at t=0. Main partnerships are displayed in blue, and casual partnerships are displayed in red.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS). Getting to Zero: 2011-2015 Strategy. 2010; :ISBN 978-92-9173-883-0.
    1. National Alliance of State and Territorial AIDS Directors (NASTAD). ENDING THE HIV EPIDEMIC: JURISDICTIONAL PLANS. 2018.
    1. Getting to Zero Exploratory Workgroup. Getting To Zero: A Framework to Eliminate HIV in Illinois. ; 2017. https://www.aidschicago.org/resources/content/1/1/1/3/documents/GTZ_fram... (accessed 2 Oct2018).
    1. Khanna AS, Skwara A, Collier N, Ozik J, Issema R, Di Paola A, et al. Getting to Zero: Triangulating HIV Incidence Predictions from Micro-Level Network Modeling and Macro-Level Incidence Projections In: Society for Prevention Research.Washington, D.C.: ; 2018. https://spr.confex.com/spr/spr2018/webprogram/Session8631.html
    1. Illinois Department of Public Health. Data and Statistics: HIV Fact Sheets: Men Who Have Sex with Men ; 2016. http://www.dph.illinois.gov/sites/default/files/publications/MSM-Factshe... (accessed 2 Oct2018).

Publication types