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Expanded PrEP use in San Francisco could reduce infection rate
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SEATTLE — A model predicting HIV transmission in San Francisco with expanded use of pre-exposure prophylaxis suggests that the number of new infections could decrease by 50% throughout the city, according to data presented at CROI 2015.
“San Francisco is an early adopter and sentinel of HIV prevention strategies, including routine HIV testing, nucleic acid testing, early HIV treatment and grassroots initiatives such as seroadaptive sexual practices,” Robert M. Grant, MD, MPH, Betty Jean and Hiro Ogawa Endowed Investigator with the Gladstone Institutes in San Francisco, said during his presentation. “PrEP use started to rise in San Francisco in 2013, but goals for PrEP scale-up have not yet been established.”
Robert M. Grant
Data from surveys of sexual practices and PrEP use among men who have sex with men indicated that 16,089 HIV-negative individuals are at substantial risk for HIV and are eligible for PrEP, Grant said. However, only 5,059 of those reported PrEP use in the past year, meaning only 31% of eligible people were using PrEP. Using data from the iPrEx Open Label Extension (OLE) trial in San Francisco, Grand and colleagues calculated the potential impact of PrEP scale-up.
Among the 150 participants in the iPrEx OLE trial, 64% chose to start PrEP, and adherence led to protective drug concentrations among 96% of the users. In the model, they predicted that if 6,400 people used PrEP, the number of new infections could decrease by 50%. If the number of people on PrEP was 12,800, the number of new infections per year would be less than 50, corresponding with an 86% reduction.
“The next steps are to compare the model predictions with new infections in 2014 and improve metrics for population viral suppression, PrEP use and migration patterns,” Grant said. “More information is needed about women, including transwomen.”
To increase PrEP rollout, Grant said it would require: community education, PrEP stigma interventions, navigators for health insurance and benefits programs, expansion of STI clinic hours to allow PrEP, practical training for health care providers and referral networks for complicated situations. – by Emily Shafer
Reference:
Grant RM, et al. Abstract 25. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.
Disclosure: Grant reports financial relationships with Gilead Sciences, Siemens and ViiV Healthcare.