Estimating the impact of HIV PrEP regimens containing long-acting injectable cabotegravir or daily oral tenofovir disoproxil fumarate/emtricitabine among men who have sex with men in the United States: a mathematical modelling study for HPTN 083.
Kate M Mitchell, Marie-Claude Boily, Brett Hanscom, Mia Moore, Jeffery Todd, Gabriela Paz-Bailey, Cyprian Wejnert, Albert Liu, Deborah J Donnell, Beatriz Grinsztejn, Raphael J Landovitz, Dobromir T Dimitrov
Author Information
Kate M Mitchell: MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
Marie-Claude Boily: MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
Brett Hanscom: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Mia Moore: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Jeffery Todd: Centers for Disease Control and Prevention, Atlanta, GA, USA.
Gabriela Paz-Bailey: Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
Cyprian Wejnert: Centers for Disease Control and Prevention, Atlanta, GA, USA.
Albert Liu: Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA.
Deborah J Donnell: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Beatriz Grinsztejn: Instituto Nacional de Infectologia Evandro Chagas, Funda����o Oswaldo Cruz, Rio de Janeiro, Brazil.
Raphael J Landovitz: Center for Clinical AIDS Research and Education, University of California Los Angeles, Los Angeles, CA, USA.
Dobromir T Dimitrov: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Background: The HPTN 083 trial demonstrated superiority of HIV pre-exposure prophylaxis (PrEP) containing long-acting injectable cabotegravir (CAB) to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) among men who have sex with men (MSM). We compared the potential population-level impact of TDF/FTC and CAB among MSM in Atlanta, Georgia. Methods: An MSMHIV transmission model was calibrated to Atlanta-specific data on HIV prevalence and PrEP usage (percentage of uninfected MSM on PrEP), assuming only PrEP-indicated MSM used PrEP. CAB effectiveness (efficacy �� adherence) of 91% was estimated using data from HPTN 083 and previous TDF/FTC trials. We estimated HIVinfections averted over 5/10 years if TDF/FTC use were maintained, or if all TDF/FTC users switched to CAB in January 2022 (vs. no PrEP or continued TDF/FTC use). CAB scenarios with 10%/20% more users were also considered. Progress towards Ending the HIV Epidemic (EHE) goals (75%/90% fewer HIVinfections in 2025/2030 vs. 2017) was estimated. Findings: We predicted TDF/FTC at current usage (���28%) would avert 36.3% of new HIVinfections (95% credible interval 25.6-48.7%) among all Atlanta MSM over 2022-2026 vs. no PrEP. Switching to CAB with similar usage may prevent 44.6% (33.2-56.6%) infections vs. no PrEP and 11.9% (5.2-20.2%) infections vs. continued TDF/FTC. Increasing CAB usage 20% could increase the incremental impact over TDF/FTC to 30.0% over 2022-2026, getting ���60% towards reaching EHE goals (47%/54% fewer infections in 2025/2030). Reaching the 2030 EHE goal would require 93% CAB usage. Interpretation: If CAB effectiveness were like HPTN 083, CAB could prevent more infections than TDF/FTC at similar usage. Increased CAB usage could contribute substantially towards reaching EHE goals, but the usage required to meet EHE goals is unrealistic. Funding: NIH, MRC.
