Gonorrhoea and chlamydia diagnosis as an entry point for HIV pre-exposure prophylaxis: a modelling study

Abstract

ObjectivesNeisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown.DesignAn agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study.SettingBaltimore City, Maryland, USA.InterventionsPrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted).Main outcomeThe projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year.ResultsAssuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community.ConclusionsTargeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.

Estimating Partnership Duration among MSM in Belgium—A Modeling Study

“…Estimates for partnership durations and homophily rates were similar in all three scenarios, indicating quite robust results. The estimates for the duration of steady partnerships were comparable to the data reported by the ACS study [ 56 ] (1355 days), as well as studies from Hui et al [ 22 , 23 , 24 ] and Kasaie et al [ 26 ], all reporting an average duration of 4 years. The average duration for persistent casual partnerships was affected by the activity group of the two partners, with a much shorter duration if one of the two partners was a HA-MSM.…”

“…Several modeling studies have described the transmission of CT and NG among MSM [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], which cluster in a few Western countries, mainly from the US [ 9 , 13 , 14 , 19 , 25 , 26 , 27 , 28 , 35 , 36 ] and Australia [ 18 , 22 , 23 , 24 , 32 , 40 , 41 , 42 , 43 ]. In Europe, notable modeling studies have been conducted in the UK [ 31 , …”

“…Many models mention the lack of parameters in the literature to inform simulation models, leading to limitations in the validity and interpretation of the results [ 8 , 16 , 17 , 18 , 26 , 29 , 32 , 34 , 35 , 40 , 41 , 43 , 45 ]. Besides transmission probabilities that are difficult to calculate in a clinical setting, high-quality clinical parameters such as the probability of symptoms and time intervals until recovery are not readily available in the literature, especially when reported by different anatomical sites [ 46 , 47 ].…”

Knowledge domain and emerging trends in HIV pre-exposure prophylaxis: A visualization analysis via CiteSpace

“…Research shows that HIV-infected men who have sex with men (MSM) have a high prevalence of asymptomatic rectal chlamydia ( Xiridou et al, 2013 ). From a biological standpoint, there was evidence that chlamydia infection increased one’s susceptibility to HIV acquisition, with rectal infection being the most likely to do so ( Kasaie et al, 2019 ). Relevant experimental conclusions prove that HIV transmission could be facilitated by chlamydia infection among MSM.…”

Trends in HIV prevalence by self-report among MSM diagnosed and reported with gonorrhea in six United States jurisdictions from 2010 to 2019

“…This is a promising finding that may reflect early and intensified public health efforts in these jurisdictions to reduce the incidence of HIV through interventions including PrEP and TasP, in New York City's 'Undetectable¼Untransmittable' (U¼U) and San Francisco's 'Getting to Zero' campaigns. Key concepts of these campaigns are now an integral part of the national Ending the Epidemic (EHE) initiative [15][16][17][18][19][20][21][22]. Gonorrhea transmission may also have peaked among MSM living with HIV in these areas and shifted toward HIV-negative MSM.…”