Modeling the impact of different PrEP targeting strategies combined with a clinic-based HIV-1 nucleic acid testing intervention in Kenya

IF 3 3区医学 Q2 INFECTIOUS DISEASES

Epidemics Pub Date : 2023-09-01 DOI:10.1016/j.epidem.2023.100696

Deven T. Hamilton , Clara Agutu , Martin Sirengo , Wairimu Chege , Steven M. Goodreau , Adam Elder , Eduard J. Sanders , Susan M. Graham

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引用次数: 0

Abstract

Background

Up to 69% of adults who acquire HIV in Kenya seek care for acute retroviral symptoms, providing an important opportunity for early diagnosis and HIV care engagement. The Tambua Mapema Plus (TMP) trial tested a combined HIV-1 nucleic acid testing, linkage, treatment, and partner notification intervention for adults with symptoms of acute HIV infection presenting to health facilities in coastal Kenya. We estimated the potential impact on the Kenyan HIV epidemic of providing PrEP to individuals testing negative in TMP, if scaled up.

Methods

We developed an agent-based simulation of HIV-1 transmission using TMP data and current Kenyan statistics. PrEP interventions were layered onto a model of TMP as standard of care, to estimate additional potential population-level impact of enrolling HIV-negative individuals identified through TMP on PrEP over 10 years. Four scenarios were modeled: PrEP for uninfected individuals in disclosed serodiscordant couples; PrEP for individuals with concurrent partnerships; PrEP for all uninfected individuals identified through TMP; and PrEP integrated into the enhanced partner services component of TMP.

Findings

Providing PrEP to both individuals with concurrent partnerships and uninfected partners identified through enhanced partner services reduced new HIV infections and was efficient based on numbers needed to treat (NNT). The mean percent of infections averted was 2.79 (95%SI:−10.83, 15.24) and 4.62 (95%SI:−9.5, 16.82) when PrEP uptake was 50% and 100%, respectively, and median NNT was 22.54 (95%SI:not defined, 6.45) and 27.55 (95%SI:not defined, 11.0), respectively. Providing PrEP for all uninfected individuals identified through TMP averted up to 12.68% (95%SI:0.17, 25.19) of new infections but was not efficient based on the NNT: 200.24 (95%SI:523.81, 123.23).

Conclusions

Providing PrEP to individuals testing negative for HIV-1 nucleic acid after presenting to a health facility with symptoms compatible with acute HIV adds value to the TMP intervention, provided PrEP is targeted effectively and efficiently.

Funding

National Institutes of Health, Sub-Saharan African Network for TB/HIV Research Excellence.

查看原文本刊更多论文

肯尼亚不同PrEP靶向策略与临床HIV-1核酸检测干预相结合的影响建模。

背景：在肯尼亚，高达69%的感染艾滋病毒的成年人寻求急性逆转录病毒症状的护理，这为早期诊断和参与艾滋病毒护理提供了重要机会。Tambua Mapema Plus（TMP）试验对肯尼亚沿海卫生机构出现急性艾滋病毒感染症状的成年人进行了HIV-1核酸检测、联系、治疗和伴侣通知干预的联合试验。我们估计，如果扩大规模，向TMP检测呈阴性的个人提供PrEP对肯尼亚艾滋病毒流行的潜在影响。方法：我们利用TMP数据和肯尼亚最新统计数据，开发了一个基于代理的HIV-1传播模拟。PrEP干预措施被分层到TMP作为护理标准的模型上，以估计通过TMP识别的HIV阴性个体在10年内对PrEP的额外潜在人群影响。对四种情况进行了建模：公开的血清不一致夫妇中未感染个体的PrEP；PrEP适用于同时拥有合伙关系的个人；通过TMP鉴定的所有未感染个体的PrEP；PrEP集成到TMP的增强型合作伙伴服务组件中。研究结果：向同时有伴侣关系的个人和通过加强伴侣服务确定的未感染伴侣提供PrEP可以减少新的艾滋病毒感染，并且根据需要治疗的人数是有效的（NNT）。当PrEP摄取量分别为50%和100%时，避免感染的平均百分比分别为2.79（95%SI:10.83，15.24）和4.62（95%SI:-9.5，16.82），中位NNT分别为22.54（95%SI:未定义，6.45）和27.55（95%SI：未定义，11.0）。通过TMP为所有未感染的个体提供PrEP避免了高达12.68%（95%SI:0.17，25.19）的新感染，但基于NNT:200.24（95%SI:52381123.23）是无效的，只要PrEP是有效和高效的靶向物。资助：国立卫生研究院，撒哈拉以南非洲结核病/艾滋病卓越研究网络。

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来源期刊

Epidemics INFECTIOUS DISEASES-

CiteScore

6.00

自引率

7.90%

发文量

审稿时长

140 days

期刊介绍： Epidemics publishes papers on infectious disease dynamics in the broadest sense. Its scope covers both within-host dynamics of infectious agents and dynamics at the population level, particularly the interaction between the two. Areas of emphasis include: spread, transmission, persistence, implications and population dynamics of infectious diseases; population and public health as well as policy aspects of control and prevention; dynamics at the individual level; interaction with the environment, ecology and evolution of infectious diseases, as well as population genetics of infectious agents.