Abstract
UNAIDS has identified the Danish HIV epidemic in men who have sex with men (MSM) as a priority for elimination. Incidence is close to the elimination threshold of one new infection per year per 1,000 individuals. However, surveillance data show that HIV strains are being imported into Denmark, mainly due to travel. We use a transmission model to predict (from 2018 to 2030) the impact of pre-exposure prophylaxis (PrEP) on incidence. Our model reflects the current epidemic and diagnosis rates in the Danish MSM community. We conduct a sensitivity analysis based on 20,000 simulations, and assume that PrEP coverage could range from zero to 50% and diagnosis rates increase up to three-fold. We predict that incidence will fall below the elimination threshold, even without the introduction of PrEP, reaching 0.87 (median, 95% Confidence Interval: 0.65–1.23) new infections per 1,000 MSM by 2030. PrEP could reduce incidence to well below the threshold, if it results in a significant increase in diagnosis rates and reduces the number of infections occurring abroad. The Danish Medicine Agency and Danish Health Authority have recommended introducing PrEP. Our study provides strong support for this recommendation, and shows the importance of Danish MSM using PrEP when abroad.
Highlights
The Danish HIV epidemic in men who have sex with men (MSM), an epidemic UNAIDS has identified as a priority for elimination[1], is approaching the WHO elimination threshold of one new HIV infection per year per 1,000 individuals[2]
We have previously shown that treatment as prevention” (TasP) had reduced incidence in Danish MSM close to the WHO elimination threshold by 20132
Using data from the Danish HIV Cohort Study (DHCS) and a transmission model, we predict that without any change in current conditions, incidence in Danish MSM will fall below the elimination threshold before 2030
Summary
The Danish HIV epidemic in men who have sex with men (MSM), an epidemic UNAIDS has identified as a priority for elimination[1], is approaching the WHO elimination threshold of one new HIV infection per year per 1,000 individuals[2]. We have shown previously that incidence has continuously decreased over the past two decades as a result of a high coverage of treatment[2]. These results are based on data from the Danish HIV Cohort Study (DHCS), an ongoing nationwide population-based study[3,4]. We predict the potential impact of PrEP on the HIV epidemic in MSM in Denmark as incidence approaches the elimination threshold. Danish surveillance data show that strains from other countries have been, and continue to be, imported into Denmark: ~13% of new HIV infections in Danish MSM are acquired when travelling abroad[11]. In Denmark, as in many other countries, all HIV-infected individuals are eligible for treatment regardless of their CD4 cell count
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