Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data
Abstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population‐level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013–2021. Meth...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-12-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26194 |
| _version_ | 1827397783434297344 |
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| author | Carla M. Doyle Rachael M. Milwid Joseph Cox Yiqing Xia Gilles Lambert Cécile Tremblay Joanne Otis Marie‐Claude Boily Jean‐Guy Baril Réjean Thomas Alexandre Dumont Blais Benoit Trottier Daniel Grace David M. Moore Sharmistha Mishra Mathieu Maheu‐Giroux |
| author_facet | Carla M. Doyle Rachael M. Milwid Joseph Cox Yiqing Xia Gilles Lambert Cécile Tremblay Joanne Otis Marie‐Claude Boily Jean‐Guy Baril Réjean Thomas Alexandre Dumont Blais Benoit Trottier Daniel Grace David M. Moore Sharmistha Mishra Mathieu Maheu‐Giroux |
| author_sort | Carla M. Doyle |
| collection | DOAJ |
| description | Abstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population‐level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013–2021. Methods We used an agent‐based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID‐19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual‐level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post‐exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free‐of‐charge), and improving retention. Results Over 2013–2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3–0.6) to 0.2 (90% CrI: 0.1–0.2) per 100 person‐years. PrEP coverage among HIV‐negative MSM remained low until 2015 (<1%). Afterwards, coverage increased to a maximum of 10% of all HIV‐negative MSM, or about 16% of the 62% PrEP‐eligible HIV‐negative MSM in 2020. Over 2015–2021, PrEP averted an estimated 20% (90% CrI: 11%–30%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%–42%) of HIV acquisitions from 2015‐2021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV‐negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%–70%) of HIV acquisitions from 2015 to 2021. Conclusions PrEP reduced population‐level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition. |
| first_indexed | 2024-03-08T19:17:37Z |
| format | Article |
| id | doaj.art-83446fce4e3c49f9b4918f7760c7099a |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-08T19:17:37Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-83446fce4e3c49f9b4918f7760c7099a2023-12-27T05:20:28ZengWileyJournal of the International AIDS Society1758-26522023-12-012612n/an/a10.1002/jia2.26194Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey dataCarla M. Doyle0Rachael M. Milwid1Joseph Cox2Yiqing Xia3Gilles Lambert4Cécile Tremblay5Joanne Otis6Marie‐Claude Boily7Jean‐Guy Baril8Réjean Thomas9Alexandre Dumont Blais10Benoit Trottier11Daniel Grace12David M. Moore13Sharmistha Mishra14Mathieu Maheu‐Giroux15Department of Epidemiology and Biostatistics School of Population and Global Health McGill University Montréal Québec CanadaDepartment of Epidemiology and Biostatistics School of Population and Global Health McGill University Montréal Québec CanadaDepartment of Epidemiology and Biostatistics School of Population and Global Health McGill University Montréal Québec CanadaDepartment of Epidemiology and Biostatistics School of Population and Global Health McGill University Montréal Québec CanadaDirection Régionale de Santé Publique de Montréal Montréal Québec CanadaCentre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) Montréal Québec CanadaDépartement de Sexologie Université du Québec à Montréal Montréal Québec CanadaMRC Centre for Global Infectious Disease Analysis School of Public Health Imperial College London London UKDepartment of Family Medicine Centre Hospitalier de l'Université de Montréal Montréal Québec CanadaClinique médicale l'Actuel Montréal Québec CanadaRÉZO Health and STI prevention for GBQ men, trans people and MSM Montréal Québec CanadaClinique de médecine urbaine du Quartier Latin Montréal Québec CanadaDalla Lana School of Public Health University of Toronto Toronto Ontario CanadaBC Centre for Excellence in HIV/AIDS Vancouver British Columbia CanadaDepartment of Medicine St. Michael's Hospital University of Toronto Toronto Ontario CanadaDepartment of Epidemiology and Biostatistics School of Population and Global Health McGill University Montréal Québec CanadaAbstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population‐level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013–2021. Methods We used an agent‐based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID‐19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual‐level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post‐exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free‐of‐charge), and improving retention. Results Over 2013–2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3–0.6) to 0.2 (90% CrI: 0.1–0.2) per 100 person‐years. PrEP coverage among HIV‐negative MSM remained low until 2015 (<1%). Afterwards, coverage increased to a maximum of 10% of all HIV‐negative MSM, or about 16% of the 62% PrEP‐eligible HIV‐negative MSM in 2020. Over 2015–2021, PrEP averted an estimated 20% (90% CrI: 11%–30%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%–42%) of HIV acquisitions from 2015‐2021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV‐negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%–70%) of HIV acquisitions from 2015 to 2021. Conclusions PrEP reduced population‐level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition.https://doi.org/10.1002/jia2.26194antiretroviralcombination preventioneliminationepidemiologyimpact evaluationmathematical modelling |
| spellingShingle | Carla M. Doyle Rachael M. Milwid Joseph Cox Yiqing Xia Gilles Lambert Cécile Tremblay Joanne Otis Marie‐Claude Boily Jean‐Guy Baril Réjean Thomas Alexandre Dumont Blais Benoit Trottier Daniel Grace David M. Moore Sharmistha Mishra Mathieu Maheu‐Giroux Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data Journal of the International AIDS Society antiretroviral combination prevention elimination epidemiology impact evaluation mathematical modelling |
| title | Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data |
| title_full | Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data |
| title_fullStr | Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data |
| title_full_unstemmed | Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data |
| title_short | Population‐level effectiveness of pre‐exposure prophylaxis for HIV prevention among men who have sex with men in Montréal (Canada): a modelling study of surveillance and survey data |
| title_sort | population level effectiveness of pre exposure prophylaxis for hiv prevention among men who have sex with men in montreal canada a modelling study of surveillance and survey data |
| topic | antiretroviral combination prevention elimination epidemiology impact evaluation mathematical modelling |
| url | https://doi.org/10.1002/jia2.26194 |
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