Gonorrhoea and chlamydia diagnosis as an entry point for HIV pre-exposure prophylaxis: A modelling study

Parastu Kasaie, Christina Schumacher, Jacky Jennings, Stephen Berry, Susan Tuddenham, Maunank Shah, Eli S. Rosenberg, Karen W. Hoover, Thomas L. Gift, Harrell Chesson, Danielle German, David Wesley Dowdy

Research output: Contribution to journalArticle

Abstract

Objectives Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown. Design An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study. Setting Baltimore City, Maryland, USA. Interventions PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted). Main outcome The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year. Results Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community. Conclusions Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.

Original languageEnglish (US)
Article number023453
JournalBMJ open
Volume9
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Chlamydia
Gonorrhea
Neisseria gonorrhoeae
Chlamydia trachomatis
HIV
Uncertainty
Pre-Exposure Prophylaxis
Baltimore
Incidence
Censuses

Keywords

  • Chlamydia
  • Computer simulation
  • Gonorrhea
  • HIV infection
  • Homosexuality
  • Pre-exposure prophylaxis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{cba554ea511a4f1a98fc40df120bf7e9,
title = "Gonorrhoea and chlamydia diagnosis as an entry point for HIV pre-exposure prophylaxis: A modelling study",
abstract = "Objectives Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown. Design An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study. Setting Baltimore City, Maryland, USA. Interventions PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted). Main outcome The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year. Results Assuming 60{\%} uptake and 60{\%} adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4{\%} (95{\%} uncertainty range (UR) 10.3{\%} to 14.4{\%}) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50{\%} annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0{\%} (95{\%} UR 20.1{\%} to 23.9{\%}) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95{\%} UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95{\%} UR 1.2 to 2.2) times relative to evaluating random MSM from the community. Conclusions Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.",
keywords = "Chlamydia, Computer simulation, Gonorrhea, HIV infection, Homosexuality, Pre-exposure prophylaxis",
author = "Parastu Kasaie and Christina Schumacher and Jacky Jennings and Stephen Berry and Susan Tuddenham and Maunank Shah and Rosenberg, {Eli S.} and Hoover, {Karen W.} and Gift, {Thomas L.} and Harrell Chesson and Danielle German and Dowdy, {David Wesley}",
year = "2019",
month = "3",
day = "1",
doi = "10.1136/bmjopen-2018-023453",
language = "English (US)",
volume = "9",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",

}

TY - JOUR

T1 - Gonorrhoea and chlamydia diagnosis as an entry point for HIV pre-exposure prophylaxis

T2 - A modelling study

AU - Kasaie, Parastu

AU - Schumacher, Christina

AU - Jennings, Jacky

AU - Berry, Stephen

AU - Tuddenham, Susan

AU - Shah, Maunank

AU - Rosenberg, Eli S.

AU - Hoover, Karen W.

AU - Gift, Thomas L.

AU - Chesson, Harrell

AU - German, Danielle

AU - Dowdy, David Wesley

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objectives Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown. Design An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study. Setting Baltimore City, Maryland, USA. Interventions PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted). Main outcome The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year. Results Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community. Conclusions Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.

AB - Objectives Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown. Design An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study. Setting Baltimore City, Maryland, USA. Interventions PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted). Main outcome The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year. Results Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community. Conclusions Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.

KW - Chlamydia

KW - Computer simulation

KW - Gonorrhea

KW - HIV infection

KW - Homosexuality

KW - Pre-exposure prophylaxis

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U2 - 10.1136/bmjopen-2018-023453

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