HIV PrEP Investments Should Consider Intervention Interdependence

Public health investments that target the human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) cascade of care should account for the interdependence of initiation, adherence, and persistence interventions, suggest study findings published online ahead of print in the journal AIDS.

The study paired a stochastic network-based HIV transmission model with an economic budget optimization model for men who have sex with men in the Atlanta area. The resulting model included up to three PrEP cascade interventions that aimed to improve initiation, adherence, or persistence.

From a 15% PrEP coverage level at baseline, the trio of interventions could raise coverage to 27%, according to the study. Over 10 years, 12.3% of infections could be avoided.

“Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention,” researchers wrote. “As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention.”

When adherence intervention costs were cut by half, the optimal investment was more equal across the three interventions, researchers pointed out.

“Given current intervention efficacy estimates,” they wrote, “the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs.”

Reference:

Jenness SM, Knowlton G, Smith DK, et al. A decision analytics model to optimize investment in interventions targeting the HIV PrEP cascade of care [published online ahead of print, 2021 Apr 6]. AIDS. 2021;10.1097/QAD.0000000000002909. doi:10.1097/QAD.0000000000002909