Estimating benefits of using on-demand oral prep by MSM: a comparative modeling study of the US and ThailandResearch in context

Background: Daily and on-demand pre-exposure prophylaxis (PrEP) are effective at preventing HIV acquisition among men who have sex with men (MSM), but only daily PrEP is approved in the US. On-demand PrEP may improve uptake and adherence. We identify sub-groups of MSM who would benefit from on-deman...

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Bibliographic Details
Published in:EClinicalMedicine 2023-02, Vol.56, p.101776
Main Authors: Sarah E. Stansfield, Mia Moore, Marie-Claude Boily, James P. Hughes, Deborah J. Donnell, Dobromir T. Dimitrov
Format: Article
Language:English
Subjects:
2-1-1 PrEP
HIV
Mathematical model
MSM
On-demand PrEP
PrEP
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Summary:Background: Daily and on-demand pre-exposure prophylaxis (PrEP) are effective at preventing HIV acquisition among men who have sex with men (MSM), but only daily PrEP is approved in the US. On-demand PrEP may improve uptake and adherence. We identify sub-groups of MSM who would benefit from on-demand PrEP and determine effectiveness achieved if individuals used their optimal regimens. Methods: Using data from the HPTN 067 study (study period 2012–2014), we created an individual-based stochastic model of HIV risk in two synthetic MSM populations with parameters separately estimated using data from Harlem, US, and Bangkok, Thailand. Agents were assigned daily and on-demand PrEP for six months each. Two personalized PrEP assignments: optimal, based on improved predicted effectiveness and reduced pill burden, and adherence-based, using daily PrEP adherence, were simulated for another six months. Findings: Simulated on-demand PrEP was optimal for approximately one-third of MSM. It was assigned mainly to those with low daily PrEP adherence (88% (Harlem), 95% (Bangkok) of MSM with daily PrEP adherence
ISSN:2589-5370
2589-5370