Potential impact of pre‐exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study

• Published in: Journal of the International AIDS Society Vol. 19; no. 1; pp. 20942 - n/a
• Main Authors: Mitchell, Kate M, Prudden, Holly J, Washington, Reynold, Isac, Shajy, Rajaram, Subramanian P, Foss, Anna M, Terris‐Prestholt, Fern, Boily, Marie‐Claude, Vickerman, Peter
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.01.2016; John Wiley & Sons, Inc; Wiley
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS/HIV; Analysis; Care and treatment; Condoms; Cost analysis; Disease prevention; Disease transmission; Efficiency; Epidemics; Epidemiology; Female; Females; focussed intervention; Health aspects; Heterosexuality; high‐risk group; HIV; HIV infection; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - psychology; Homosexuality, Male - psychology; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; India - epidemiology; Infections; Intervention; key population; Male; Medical research; Medical statistics; Medical tests; Models, Theoretical; MSM (Men who have sex with men); oral PrEP; Population; Pre-Exposure Prophylaxis; Prevention; prioritizing; Prophylaxis; Prostitutes; Public health; Risk factors; Sex industry; Sex oriented businesses; Sex Workers - statistics & numerical data; Sexually transmitted diseases; Statistics; STD; targeting; Trends; Women; Working women; India; targeting; key population; high-risk group; oral PrEP; focussed intervention; prevention; prioritizing
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.19.1.20942

Introduction In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre‐exposure prophylaxis (PrEP) has high anti‐HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore. Methods A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low‐risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life‐years gained) and efficiency (life‐years gained/infections averted per 100 person‐years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high‐risk men who have sex with men, both female sex workers and high‐risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations. Results Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use. Conclusions PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.