Impact of sexual trajectories of men who have sex with men on the reduction in HIV transmission by pre-exposure prophylaxis

Ganna Rozhnova; Janneke C M Heijne; Maartje Basten; Chantal den Daas; Amy Matser; Mirjam Kretzschmar

doi:10.1016/j.epidem.2019.03.003

Impact of sexual trajectories of men who have sex with men on the reduction in HIV transmission by pre-exposure prophylaxis

Epidemics. 2019 Sep:28:100337. doi: 10.1016/j.epidem.2019.03.003. Epub 2019 Mar 14.

Authors

Ganna Rozhnova¹, Janneke C M Heijne², Maartje Basten³, Chantal den Daas⁴, Amy Matser⁵, Mirjam Kretzschmar⁶

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Electronic address: G.Rozhnova@umcutrecht.nl.
² Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
⁴ Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.
⁵ Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
⁶ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.

PMID: 31126778
DOI: 10.1016/j.epidem.2019.03.003

Abstract

Changes in sexual risk behavior over the life course in men who have sex with men (MSM) can influence population-level intervention efficacy. Our objective was to investigate the impact of incorporating sexual trajectories describing long-term changes in risk levels on the reduction in HIV prevalence by pre-exposure prophylaxis (PrEP) among MSM. Based on the Amsterdam Cohort Study data, we developed two models of HIV transmission in a population stratified by sexual behavior. In the first model, individuals were stratified into low, medium and high risk levels and did not change their risk levels. The second model had the same stratification but incorporated additionally three types of sexual behavior trajectories. The models assumed universal antiretroviral treatment of HIV⁺ MSM, and PrEP use by high risk HIV^- MSM. We computed the relative reduction in HIV prevalence in both models for annual PrEP uptakes of 10% to 80% at different time points after PrEP introduction. We then investigated the impact of sexual trajectories on the effectiveness of PrEP intervention. The impact of sexual trajectories on the overall prevalence and prevalence in individuals at low, medium and high risk levels varied with PrEP uptake and time after PrEP introduction. Compared to the model without sexual trajectories, the model with trajectories predicted a higher impact of PrEP on the overall prevalence, and on the prevalence among the medium and high risk individuals. In low risk individuals, there was more reduction in prevalence during the first 15 years of PrEP intervention if sexual trajectories were not incorporated in the model. After that point, at low risk level there was more reduction in the model with trajectories. In conclusion, our study predicts that sexual trajectories increase the estimated impact of PrEP on reducing HIV prevalence when compared to a population where risk levels do not change.

Keywords: HIV transmission; Men who have sex with men; Pre-exposure prophylaxis; Sexual behavior change; Sexual behavior trajectories.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-HIV Agents
Cohort Studies
HIV Infections / epidemiology*
HIV Infections / prevention & control*
HIV Infections / psychology
Homosexuality, Male / psychology*
Humans
Male
Middle Aged
Pre-Exposure Prophylaxis*
Prevalence
Risk-Taking
Sexual Behavior*
Sexual and Gender Minorities / psychology*

Substances

Anti-HIV Agents