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Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision

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. 2020 Dec 31;15(12):e0244761. doi: 10.1371/journal.pone.0244761. eCollection 2020. Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision

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Individual and community-level benefits of PrEP in western Kenya and South Africa: Implications for population prioritization of PrEP provision

Edinah Mudimu et al. PLoS One. 2020.

. 2020 Dec 31;15(12):e0244761. doi: 10.1371/journal.pone.0244761. eCollection 2020. Affiliations

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Abstract

Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV and has the potential to significantly impact the HIV epidemic. Given limited resources for HIV prevention, identifying PrEP provision strategies that maximize impact is critical.

Methods: We used a stochastic individual-based network model to evaluate the direct (infections prevented among PrEP users) and indirect (infections prevented among non-PrEP users as a result of PrEP) benefits of PrEP, the person-years of PrEP required to prevent one HIV infection, and the community-level impact of providing PrEP to populations defined by gender and age in western Kenya and South Africa. We examined sensitivity of results to scale-up of antiretroviral therapy (ART) and voluntary medical male circumcision (VMMC) by comparing two scenarios: maintaining current coverage ("status quo") and rapid scale-up to meet programmatic targets ("fast-track").

Results: The community-level impact of PrEP was greatest among women aged 15-24 due to high incidence, while PrEP use among men aged 15-24 yielded the highest proportion of indirect infections prevented in the community. These indirect infections prevented continue to increase over time (western Kenya: 0.4-5.5 (status quo); 0.4-4.9 (fast-track); South Africa: 0.5-1.8 (status quo); 0.5-3.0 (fast-track)) relative to direct infections prevented among PrEP users. The number of person-years of PrEP needed to prevent one HIV infection was lower (59 western Kenya and 69 in South Africa in the status quo scenario; 201 western Kenya and 87 in South Africa in the fast-track scenario) when PrEP was provided only to women compared with only to men over time horizons of up to 5 years, as the indirect benefits of providing PrEP to men accrue in later years.

Conclusions: Providing PrEP to women aged 15-24 prevents the greatest number of HIV infections per person-year of PrEP, but PrEP provision for young men also provides indirect benefits to women and to the community overall. This finding supports existing policies that prioritize PrEP use for young women, while also illuminating the community-level benefits of PrEP availability for men when resources permit.

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Conflict of interest statement

I have read the journal’s policy and one of the authors of this manuscript has the following competing interests: KK is employed by a commercial company: Avenir Health. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products to declare.

Figures

Fig 1. Direct prevention and total averted…

Fig 1. Direct prevention and total averted infections compared to status quo and fast-track baseline…

 Fig 1. Direct prevention and total averted infections compared to status quo and fast-track baseline scenarios in South Africa and a status quo baseline scenario in Kenya.

Fig 2. Indirect-to-direct ratio of infections averted…

Fig 2. Indirect-to-direct ratio of infections averted in South Africa and Kenya.

Scenarios show results…

Fig 2. Indirect-to-direct ratio of infections averted in South Africa and Kenya.

Scenarios show results from PrEP provision by age and gender.

Fig 3. Number of person-years of PrEP…

Fig 3. Number of person-years of PrEP needed to prevent one HIV infection by country,…

 Fig 3. Number of person-years of PrEP needed to prevent one HIV infection by country, baseline scenario, and PrEP provision strategy. Similar articles Cited by References
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