Are Unequal Policies in Pre-Exposure Prophylaxis Uptake Needed to Improve Equality? An Examination Among Men Who Have Sex with Men in Los Angeles County

Nguyen, Anthony; Drabo, Emmanuel Fulgence; Garland, Wendy; Moucheraud, Corrina; Holloway, Ian W.; Leibowitz, Arleen; Suen, Sze‐chuan

doi:10.1089/apc.2022.0011

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…Out of the 42 interventions for HIV testing and PrEP uptake and adherence included in the system-atic reviews by Wang et al [34,35], approximately 30% focused on Black or Hispanic/Latinx MSM. A modelling study of PrEP allocation strategies in LA county found allocating PrEP resources preferentially to Black individuals would have a substantial positive impact on increasing equity, with disparities in HIV incidence substantially reduced [54]. While HIV incidence may already be at parity between Black and White populations in some US settings [55], differences are significant in the South, where Black individuals account for more of the overall population than other parts of the country (e.g.…”

Section: Discussionmentioning

confidence: 99%

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Enns,

Sui,

Guerra‐Alejos

et al. 2024

J Int AIDS Soc.

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IntroductionImproving the delivery of existing evidence‐based interventions to prevent and diagnose HIV is key to Ending the HIV Epidemic in the United States. Structural barriers in the access and delivery of related health services require municipal or state‐level policy changes; however, suboptimal implementation can be addressed directly through interventions designed to improve the reach, effectiveness, adoption or maintenance of available interventions. Our objective was to estimate the cost‐effectiveness and potential epidemiological impact of six real‐world implementation interventions designed to address these barriers and increase the scale of delivery of interventions for HIV testing and pre‐exposure prophylaxis (PrEP) in three US metropolitan areas.MethodsWe used a dynamic HIV transmission model calibrated to replicate HIV microepidemics in Atlanta, Los Angeles (LA) and Miami. We identified six implementation interventions designed to improve HIV testing uptake (“Academic detailing for HIV testing,” “CyBER/testing,” “All About Me”) and PrEP uptake/persistence (“Project SLIP,” “PrEPmate,” “PrEP patient navigation”). Our comparator scenario reflected a scale‐up of interventions with no additional efforts to mitigate implementation and structural barriers. We accounted for potential heterogeneity in population‐level effectiveness across jurisdictions. We sustained implementation interventions over a 10‐year period and evaluated HIV acquisitions averted, costs, quality‐adjusted life years and incremental cost‐effectiveness ratios over a 20‐year time horizon (2023–2042).ResultsAcross jurisdictions, implementation interventions to improve the scale of HIV testing were most cost‐effective in Atlanta and LA (CyBER/testing cost‐saving and All About Me cost‐effective), while interventions for PrEP were most cost‐effective in Miami (two of three were cost‐saving). We estimated that the most impactful HIV testing intervention, CyBER/testing, was projected to avert 111 (95% credible interval: 110–111), 230 (228–233) and 101 (101–103) acquisitions over 20 years in Atlanta, LA and Miami, respectively. The most impactful implementation intervention to improve PrEP engagement, PrEPmate, averted an estimated 936 (929–943), 860 (853–867) and 2152 (2127–2178) acquisitions over 20 years, in Atlanta, LA and Miami, respectively.ConclusionsOur results highlight the potential impact of interventions to enhance the implementation of existing evidence‐based interventions for the prevention and diagnosis of HIV.

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Section: Discussionmentioning

confidence: 99%

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Enns,

Sui,

Guerra‐Alejos

et al. 2024

J Int AIDS Soc.

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“…We adapted a previously published, discrete time microsimulation model of HIV among MSM, which tracks HIV disease progression and treatment dynamics according to characteristics of individual MSM on a yearly basis. 19 , 20 Specifically, the model determines the probability a susceptible individual becomes infected with HIV using the individual's demographic characteristics (age and race) and associated partnership preference pattern, number of partners, PrEP adherence, and ART adherence. See Appendix section, http://links.lww.com/QAI/C11 Model Description and Parameters for details.…”

Section: Methodsmentioning

confidence: 99%

“…Individuals exited the model when they died from HIV infection, COVID-19 infection, or other causes, and the model structure is described in detail in previous publications. 19 , 20 The code is implemented in MATLAB, 21 and the simulation code is available online at https://github.com/citina/microsimulation-sfc .…”

Section: Methodsmentioning

confidence: 99%

Impact of COVID-19 Response on the HIV Epidemic in Men Who Have Sex With Men in San Francisco County: The Importance of Rapid Return to Normalcy

Liang

Suen

Nguyen

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Self-Reported Combination HIV Prevention Strategies Enacted by a Prospective Cohort of Midlife and Older Men Who Have Sex with Men in the United States: A Latent Class Analysis

Meanley

Egan

Ware

et al. 2022

AIDS Patient Care and STDs

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Are Unequal Policies in Pre-Exposure Prophylaxis Uptake Needed to Improve Equality? An Examination Among Men Who Have Sex with Men in Los Angeles County

Cited by 4 publications

References 35 publications

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Estimating the potential value of MSM‐focused evidence‐based implementation interventions in three Ending the HIV Epidemic jurisdictions in the United States: a model‐based analysis

Impact of COVID-19 Response on the HIV Epidemic in Men Who Have Sex With Men in San Francisco County: The Importance of Rapid Return to Normalcy

Self-Reported Combination HIV Prevention Strategies Enacted by a Prospective Cohort of Midlife and Older Men Who Have Sex with Men in the United States: A Latent Class Analysis

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