BibTex format
@article{Cremin:2017:10.1016/S2352-3018(17)30021-8,
author = {Cremin, I and McKinnon, L and Kimani, J and Cherutich, P and Gakii, G and Muriuki, F and Kripke, K and Hecht, R and Kiragu, M and Smith, J and Hinsley, W and Gelmon, L and Hallett, T},
doi = {10.1016/S2352-3018(17)30021-8},
journal = {Lancet HIV},
pages = {e214--e222},
title = {Including PrEP for key populations in combination HIV prevention: a mathematical modelling analysis of Nairobi as a case-study},
url = {http://dx.doi.org/10.1016/S2352-3018(17)30021-8},
volume = {4},
year = {2017}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - Background: The role of PrEP in combination HIV prevention remains uncertain. We aimed to identify an optimal portfolio of interventions to reduce HIV incidence for a given budget, and to identify the circumstances in which PrEP could be used in Nairobi, Kenya.Methods: A mathematical model was developed to represent HIV transmission among specific key populations (female sex workers (FSW), male sex workers (MSW), and men who have sex with men (MSM)) and among the wider population of Nairobi. The scale-up of existing interventions (condom promotion, anti-retroviral therapy (ART) and male circumcision) for key populations and the wider population as have occurred in Nairobi is represented. The model includes a detailed representation of a Pre-Exposure Prophylaxis (PrEP) intervention and is calibrated to prevalence and incidence estimates specific to key populations and the wider population. Findings: In the context of a declining epidemic overall but with a large sub-epidemic among MSM and MSW, an optimal prevention portfolio for Nairobi should focus on condom promotion for MSW and MSM in particular, followed by improved ART retention, earlier ART, and male circumcision as the budget allows. PrEP for MSW could enter an optimal portfolio at similar levels of spending to when earlier ART is included, however PrEP for MSM and FSW would be included only at much higher budgets. If PrEP for MSW cost as much $500, average annual spending on the interventions modelled would need to be less than $3·27 million for PrEP for MSW to be excluded from an optimal portfolio. Estimated costs per infection averted when providing PrEP to all FSW regardless of their risk of infection, and to high risk FSW only, are $65,160 (95% credible interval: $43,520 - $90,250) and $10,920 (95% credible interval: $4,700 - $51,560) respectively. Interpretation: PrEP could be a useful contribution to combination prevention, especially for underserved key populations in Nairobi. An ongoing demonst
AU - Cremin,I
AU - McKinnon,L
AU - Kimani,J
AU - Cherutich,P
AU - Gakii,G
AU - Muriuki,F
AU - Kripke,K
AU - Hecht,R
AU - Kiragu,M
AU - Smith,J
AU - Hinsley,W
AU - Gelmon,L
AU - Hallett,T
DO - 10.1016/S2352-3018(17)30021-8
EP - 222
PY - 2017///
SN - 2405-4704
SP - 214
TI - Including PrEP for key populations in combination HIV prevention: a mathematical modelling analysis of Nairobi as a case-study
T2 - Lancet HIV
UR - http://dx.doi.org/10.1016/S2352-3018(17)30021-8
UR - https://www.sciencedirect.com/science/article/pii/S2352301817300218?via%3Dihub
VL - 4
ER -