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Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted?
Pre-exposure prophylaxis (PrEP) targeting high-risk men who have sex with men (MSM) has been shown to be a cost-effective HIV control measure. However, the approach could be a challenge in low HIV incidence places with a low proportion of high-risk MSM. To examine the impact of PrEP in such setting...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6076226/ https://www.ncbi.nlm.nih.gov/pubmed/30076362 http://dx.doi.org/10.1038/s41598-018-30101-9 |
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author | Wong, Ngai Sze Kwan, Tsz Ho Tsang, Owen T. Y. Lee, Man Po Yam, Wing Cheong Lam, Wilson Leung, Wai Shing Chan, Jacky M. C. Ho, Kai Man Lee, Shui Shan |
author_facet | Wong, Ngai Sze Kwan, Tsz Ho Tsang, Owen T. Y. Lee, Man Po Yam, Wing Cheong Lam, Wilson Leung, Wai Shing Chan, Jacky M. C. Ho, Kai Man Lee, Shui Shan |
author_sort | Wong, Ngai Sze |
collection | PubMed |
description | Pre-exposure prophylaxis (PrEP) targeting high-risk men who have sex with men (MSM) has been shown to be a cost-effective HIV control measure. However, the approach could be a challenge in low HIV incidence places with a low proportion of high-risk MSM. To examine the impact of PrEP in such setting in Asia, we developed an epidemic model and conducted cost-effectiveness analysis using empirical multicentre clinical and HIV sequence data from HIV-infected MSM in Hong Kong, in conjunction with behavioural data of local MSM. Without PrEP, the HIV incidence (per 100 person-years) would increase from 1.1 to 1.6 between 2011 and 2021. PrEP could avert 3–63% of total new infections in a five-year period (2017–2021), the variability of which depends on the implementation strategies and combination with test-and-treat. However, under current market drug price in 2016, the incremental cost per quality-adjusted life-year gained (QALYG) of PrEP (USD1583136/QALYG) is almost 3 times higher than test-and-treat intervention alone (USD396874/QALYG). Assuming 93% fall of PrEP drug price and in combination with test-and-treat, putting 30% of MSM on non-targeting PrEP would be more feasible, cost-effective (USD268915/QALYG), and could avert more new infections (40%). PrEP could contribute to HIV epidemic control in a low incidence place. |
format | Online Article Text |
id | pubmed-6076226 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-60762262018-08-07 Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? Wong, Ngai Sze Kwan, Tsz Ho Tsang, Owen T. Y. Lee, Man Po Yam, Wing Cheong Lam, Wilson Leung, Wai Shing Chan, Jacky M. C. Ho, Kai Man Lee, Shui Shan Sci Rep Article Pre-exposure prophylaxis (PrEP) targeting high-risk men who have sex with men (MSM) has been shown to be a cost-effective HIV control measure. However, the approach could be a challenge in low HIV incidence places with a low proportion of high-risk MSM. To examine the impact of PrEP in such setting in Asia, we developed an epidemic model and conducted cost-effectiveness analysis using empirical multicentre clinical and HIV sequence data from HIV-infected MSM in Hong Kong, in conjunction with behavioural data of local MSM. Without PrEP, the HIV incidence (per 100 person-years) would increase from 1.1 to 1.6 between 2011 and 2021. PrEP could avert 3–63% of total new infections in a five-year period (2017–2021), the variability of which depends on the implementation strategies and combination with test-and-treat. However, under current market drug price in 2016, the incremental cost per quality-adjusted life-year gained (QALYG) of PrEP (USD1583136/QALYG) is almost 3 times higher than test-and-treat intervention alone (USD396874/QALYG). Assuming 93% fall of PrEP drug price and in combination with test-and-treat, putting 30% of MSM on non-targeting PrEP would be more feasible, cost-effective (USD268915/QALYG), and could avert more new infections (40%). PrEP could contribute to HIV epidemic control in a low incidence place. Nature Publishing Group UK 2018-08-03 /pmc/articles/PMC6076226/ /pubmed/30076362 http://dx.doi.org/10.1038/s41598-018-30101-9 Text en © The Author(s) 2018 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Article Wong, Ngai Sze Kwan, Tsz Ho Tsang, Owen T. Y. Lee, Man Po Yam, Wing Cheong Lam, Wilson Leung, Wai Shing Chan, Jacky M. C. Ho, Kai Man Lee, Shui Shan Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? |
title | Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? |
title_full | Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? |
title_fullStr | Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? |
title_full_unstemmed | Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? |
title_short | Pre-exposure prophylaxis (PrEP) for MSM in low HIV incidence places: should high risk individuals be targeted? |
title_sort | pre-exposure prophylaxis (prep) for msm in low hiv incidence places: should high risk individuals be targeted? |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6076226/ https://www.ncbi.nlm.nih.gov/pubmed/30076362 http://dx.doi.org/10.1038/s41598-018-30101-9 |
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