Potential effectiveness of long-acting injectable pre-exposure prophylaxis for HIV prevention in men who have sex with men: a modelling study.
Brandon D L Marshall, William C Goedel, Maximilian R F King, Alyson Singleton, David P Durham, Philip A Chan, Jeffrey P Townsend, Alison P Galvani
Author Information
Brandon D L Marshall: Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. Electronic address: brandon_marshall@brown.edu.
William C Goedel: Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Maximilian R F King: Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Alyson Singleton: Department of Applied Mathematics, Brown University, Providence, RI, USA.
David P Durham: Center for Infectious Disease Modeling and Analysis, School of Public Health, Yale University, New Haven, CT, USA.
Philip A Chan: Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Jeffrey P Townsend: Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.
Alison P Galvani: Center for Infectious Disease Modeling and Analysis, School of Public Health, Yale University, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA; Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.
BACKGROUND: Oral pre-exposure prophylaxis (PrEP) prevents HIV infection in men who have sex with men (MSM); however, adherence is an ongoing concern. Long-acting injectable PrEP is being tested in phase 3 trials and could address challenges associated with adherence. We examined the potential effectiveness of long-acting injectable PrEP compared with oral PrEP in MSM. METHODS: We used an agent-based model to simulate HIV transmission in a dynamic network of 11 245 MSM in Atlanta, GA, USA. We used raw data from studies in macaque models and pharmacokinetic data from safety trials to estimate the time-varying efficacy of long-acting injectable PrEP. The effect of long-acting injectable PrEP on the cumulative number of new HIV infections over 10 years (2015-24) was compared with no PrEP and daily oral PrEP across a range of coverage levels. Sensitivity analyses were done with varying maximum efficacy and drug half-life values. FINDINGS: In the absence of PrEP, the model predicted 2374 new HIV infections (95% simulation interval [SI] 2345-2412) between 2015 and 2024. The cumulative number of new HIV infections was reduced in all scenarios in which MSM received long-acting injectable PrEP compared with oral PrEP. At a coverage level of 35%, compared with no PrEP, long-acting injectable PrEP led to a 44% reduction in new HIV infections (1044 new infections averted [95% SI 1018-1077]) versus 33% (792 infections averted [763-821]) for oral PrEP. The relative benefit of long-acting injectable PrEP was sensitive to the assumed efficacy of injections received every 8 weeks, discontinuation rates, and terminal drug half-life. INTERPRETATION: Long-acting injectable PrEP has the potential to produce larger reductions in HIV transmission in MSM than oral PrEP. However, the real-world, population-level impact of this approach will depend on uptake of this prevention method and its effectiveness, as well as retention of patients in clinical care. FUNDING: National Institute on Drug Abuse and National Institute of Mental Health.
References
J Infect Dis. 2016 Dec 15;214(12):1800-1807
[PMID: 27418048]
