ArticleJournal of the International AIDS Society2022
The impact of prevention-effective PrEP use on HIV incidence: a mathematical modelling study.
Article in Journal of the International AIDS Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Evolving landscape of economic evaluations of HIV pre-exposure prophylaxis and pre-exposure prophylaxis implementation strategies: a systematic review.Journal of the International AIDS Society · 2025Pooled it
- A Review of Network Models for HIV Spread.Journal of acquired immune deficiency syndromes (1999) · 2025Pooled it
- HIV Prevention Patterns Among a Population-Based Sample of HIV Negative Young Women in Eswatini.AIDS and behavior · 2026Article
- Interest in HIV pre-exposure prophylaxis use and associated factors among people who inject drugs in Iran: a nationwide survey in 2023.Scientific reports · 2026Article
- PrEParing for Long-acting Technologies: A Multistate Analysis of PrEP Persistence and HIV and STI Lab Coverage Among Oral PrEP Initiators in St. Louis, Missouri (2014-2021).Open forum infectious diseases · 2026Article
- Opt-in and opt-out strategies for HIV testing.The Lancet regional health. Europe · 2025Article
- Active-Controlled Trial Design for HIV Prevention Trials With a Counterfactual Placebo.Statistics in medicine · 2025Article
- Health and economic impact of oral PrEP provision across subgroups in western Kenya: a modelling analysis.BMJ global health · 2025Article
- A decade of PrEP: the evolution of HIV pre-exposure prophylaxis content and sentiments in South African print news media, 2012-2021.Culture, health & sexuality · 2024Article
- Impact of HIV self-testing for oral pre-exposure prophylaxis scale-up on drug resistance and HIV outcomes in western Kenya: a modelling study.The lancet. HIV · 2024Article
- The effects of social networks on HIV risk behaviors among Vietnamese female sex workers: a qualitative study.Global health research and policy · 2024Article
- PrEP initiation and discontinuation among transgender women in the United States: a longitudinal, mixed methods cohort study.Journal of the International AIDS Society · 2023Article
- Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women.Nature medicine · 2023Article
- Optimizing the pipeline of multipurpose prevention technologies: opportunities across women's reproductive lifespans.Frontiers in reproductive health · 2023Review
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
introductionModels that project the impact and cost-effectiveness of HIV pre-exposure prophylaxis (PrEP) must specify how PrEP use aligns with HIV exposure. We hypothesized that varying PrEP use according to individual-level partnership dynamics rather than prioritization to population subgroups based on average risk will result in larger incidence reductions and greater efficiency.
methodsWe used an individual-based network transmission model calibrated to HIV dynamics in Eswatini to simulate PrEP use among individuals ages 15-34 between 2022 and 2031 under two paradigms of PrEP delivery: "Risk Group" and "Partnership." In the "Risk Group" paradigm, we varied PrEP coverage by risk groups (low, medium and high) defined by average partnership frequency and concurrency. In the "Partnership" paradigm, all individuals are potentially eligible for PrEP, but we assumed use occurs only during partnerships and varied prioritization by partner HIV status (no prioritization to high prioritization with HIV-positive partners). We calculated person-time on PrEP and incidence relative to a no PrEP scenario and estimated efficiency as the person-years of PrEP needed to avert one additional infection (NNT).
resultsIn the Risk Group paradigm, restricting PrEP to the high-risk group was the most efficient (NNT = 17), but the number of infections averted was limited by the small size of the high-risk group. Expanding PrEP use to all risk groups averted up to three times more infections but with lower efficiency (NNT = 202). PrEP use under the Partnership paradigm was 2-6 times more efficient (NNT = 33-102) than the Risk Group paradigm with all groups eligible for PrEP. A 33% reduction in incidence among 15- to 34-year-olds was achieved at 46% (95% CI: 39-52%) PrEP coverage in the Risk Group paradigm and 6% (95% CI: 5-7%) to 17% (95% CI: 14-20%) in the Partnership paradigm.
conclusionsModelling PrEP use based on risk groups resulted in a sharp trade-off between PrEP efficiency and impact, whereas PrEP use predicated on partnerships resulted in much higher efficiency for widespread PrEP availability. Model estimates of PrEP impact and cost-effectiveness in generalized epidemics are strongly influenced by assumptions about how PrEP use aligns with individual-level HIV exposure heterogeneity.
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