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

Kate M Mitchell, Holly J Prudden, Reynold Washington, Shajy Isac, Subramanian P Rajaram, Anna M Foss, Fern Terris-Prestholt, Marie-Claude Boily, Peter Vickerman

Research output: Contribution to journalArticle (Academic Journal)peer-review

10 Citations (Scopus)
223 Downloads (Pure)

Abstract

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 prioritising 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 parameterised 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 prioritisation 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 prioritised. 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.
Original languageEnglish
Article number20942
Pages (from-to)20942
Number of pages10
JournalJournal of the International AIDS Society
Volume19
Issue number1
Early online date7 Sep 2016
DOIs
Publication statusPublished - 2016

Keywords

  • Adult
  • Female
  • HIV Infections
  • Homosexuality, Male
  • Humans
  • India
  • Male
  • Models, Theoretical
  • Pre-Exposure Prophylaxis
  • Sex Workers
  • Journal Article

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