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@article{Geidelberg:2021:10.1097/QAI.0000000000002535,
author = {Geidelberg, L and Mitchell, KM and Alary, M and Mboup, A and Béhanzin, L and Guédou, F and Geraldo, N and Goma-Matsétsé, E and Giguère, K and Aza-Gnandji, M and Kessou, L and Diallo, M and Kêkê, RK and Bachabi, M and Dramane, K and Lafrance, C and Affolabi, D and Diabaté, S and Gagnon, M-P and Zannou, DM and Gangbo, F and Silhol, R and Cianci, F and Vickerman, P and Boily, M-C},
doi = {10.1097/QAI.0000000000002535},
journal = {JAIDS: Journal of Acquired Immune Deficiency Syndromes},
pages = {e28--e42},
title = {A mathematical model impact analysis of a real-life pre-exposure prophylaxis and treatment-as-prevention study among female sex workers in Cotonou, Benin},
url = {http://dx.doi.org/10.1097/QAI.0000000000002535},
volume = {86},
year = {2021}
}

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TY  - JOUR
AB  - BACKGROUND: Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015-2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin. SETTING: Cotonou, Benin METHODS:: We developed a compartmental HIV transmission model, featuring PrEP, and ART among the high-risk (FSW, clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared to TasP. We estimated the population-level impact of the two-year study and several twenty-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage (median, 2.5th-97.5th percentile uncertainty interval (95%UI)) of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP, 49% ART) scenarios. RESULTS: The two-year study (2017 coverages: 9% PrEP, 83% ART) prevented an estimated 8% (95%UI 6-12) and 6% (3-10) infections among FSW over two and twenty years, respectively, compared to 7% (3-11) and 5% (2-9) overall. The PrEP and TasP arms prevented 0.4% (0.2-0.8) and 4.6% (2.2-8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP, 88% ART) prevented 21% (17-26) and 17% (10-27) infections among FSW respectively, and 5% (3-10) and 17% (10-27) overall. Compared to TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9x and 1.2x more infections among FSW and overall, respectively. CONCLUSIONS: The modest demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages.
AU  - Geidelberg,L
AU  - Mitchell,KM
AU  - Alary,M
AU  - Mboup,A
AU  - Béhanzin,L
AU  - Guédou,F
AU  - Geraldo,N
AU  - Goma-Matsétsé,E
AU  - Giguère,K
AU  - Aza-Gnandji,M
AU  - Kessou,L
AU  - Diallo,M
AU  - Kêkê,RK
AU  - Bachabi,M
AU  - Dramane,K
AU  - Lafrance,C
AU  - Affolabi,D
AU  - Diabaté,S
AU  - Gagnon,M-P
AU  - Zannou,DM
AU  - Gangbo,F
AU  - Silhol,R
AU  - Cianci,F
AU  - Vickerman,P
AU  - Boily,M-C
DO  - 10.1097/QAI.0000000000002535
EP  - 42
PY  - 2021///
SN  - 1525-4135
SP  - 28
TI  - A mathematical model impact analysis of a real-life pre-exposure prophylaxis and treatment-as-prevention study among female sex workers in Cotonou, Benin
T2  - JAIDS: Journal of Acquired Immune Deficiency Syndromes
UR  - http://dx.doi.org/10.1097/QAI.0000000000002535
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33105397
UR  - https://journals.lww.com/jaids/Fulltext/2021/02010/Mathematical_Model_Impact_Analysis_of_a_Real_Life.8.aspx
UR  - http://hdl.handle.net/10044/1/84051
VL  - 86
ER  -

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