Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Query Trace: Sorensen SW[original query] |
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A mathematical model of comprehensive test-and-treat services and HIV incidence among men who have sex with men in the United States
Sorensen SW , Sansom SL , Brooks JT , Marks G , Begier EM , Buchacz K , Dinenno EA , Mermin JH , Kilmarx PH . PLoS One 2012 7 (2) e29098 BACKGROUND: Early diagnosis and treatment of HIV infection and suppression of viral load are potentially powerful interventions for reducing HIV incidence. A test-and-treat strategy may have long-term effects on the epidemic among urban men who have sex with men (MSM) in the United States and may achieve the 5-year goals of the 2010 National AIDS Strategy that include: 1) lowering to 25% the annual number of new infections, 2) reducing by 30% the HIV transmission rate, 3) increasing to 90% the proportion of persons living with HIV infection who know their HIV status, 4) increasing to 85% the proportion of newly diagnosed patients linked to clinical care, and 5) increasing by 20% the proportion of HIV-infected MSM with an undetectable HIV RNA viral load. METHODS AND FINDINGS: We constructed a dynamic compartmental model among MSM in an urban population (based on New York City) that projects new HIV infections over time. We compared the cumulative number of HIV infections in 20 years, assuming current annual testing rate and treatment practices, with new infections after improvements in the annual HIV testing rate, notification of test results, linkage to care, initiation of antiretroviral therapy (ART) and viral load suppression. We also assessed whether five of the national HIV prevention goals could be met by the year 2015. Over a 20-year period, improvements in test-and-treat practice decreased the cumulative number of new infections by a predicted 39.3% to 69.1% in the urban population based on New York City. Institution of intermediate improvements in services would be predicted to meet at least four of the five goals of the National HIV/AIDS Strategy by the 2015 target. CONCLUSIONS: Improving the five components of a test-and-treat strategy could substantially reduce HIV incidence among urban MSM, and meet most of the five goals of the National HIV/AIDS Strategy. |
The cost-effectiveness of pre-exposure prophylaxis in men who have sex with men in the United States: an epidemic model
Koppenhaver RT , Sorensen SW , Farnham PG , Sansom SL . J Acquir Immune Defic Syndr 2011 58 (2) e51-2 The HIV epidemic has disproportionately affected men who have sex with men (MSM). As recently as 2006, the Centers for Disease Control and Prevention reports that MSM in the United States accounted for more than 50% of new HIV infections although representing only 2% of the US population.1 The Centers for Disease Control and Prevention also reports that in 2008, HIV prevalence among MSM in 21 major US cities was 19% with 44% being unaware of their infection. A recent study suggests that chemoprophylaxis before exposure or pre-exposure prophylaxis (PrEP) may be an effective approach to combating the incidence of HIV in the MSM community. This study showed that a daily dose of tenofovir/emtricitabine reduced HIV incidence in susceptible MSM2 by 44% overall and 73% among those who were highly adherent (high adherence defined as taking >90% of doses, determined by pill count). This suggests that PrEP has the potential to significantly reduce the HIV epidemic in the Unite States, where MSM have the highest annual incidence rate among all risk groups. Preliminary study data also indicated that, among a small sample of participants, US participants were more likely to have detectable levels of tenofovir/emtricitabine than non-US participants, suggesting that adherence rates might be high in the United States.3 However, its cost-effectiveness and overall effect on the epidemic have not been addressed in the context of these findings. | We constructed a dynamic compartmental model of MSM in an urban setting that shows changes over time in the number of susceptible and infected individuals and the various disease stages of infected individuals. We used epidemic data from New York City and national-level behavioral data. We gathered costs of implementing PrEP,4 in addition to those for tenofovir/emtricitabine (valued at $22/day).5 Our model assumed all susceptible MSM received PrEP and quarterly HIV testing and monitoring for adverse events. We assumed a 20-year time horizon and discounted the future costs, infections averted, and quality-adjusted life-years saved (QALYs) reported in incremental cost-effectiveness ratios at 3% per year. We divided PrEP drug and implementation costs by the number of cases prevented to determine the cost per case prevented. We divided PrEP drug and implementation costs minus treatment costs associated with HIV cases prevented by quality-adjusted life-years saved to determine the incremental cost-effectiveness ratio. We assumed that the costs of PrEP were fully incurred, regardless of adherence. For the purposes of this model, we compared the PrEP program described above with a scenario in which about 25% of susceptible and undiagnosed MSM are tested per year based on model projections that correspond to current epidemic trends. |
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