Abstract
BackgroundBiomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus (HIV) infection. However, China has not released national PrEP guidelines, and HIV incidence among men who have sex with men (MSM) is unchanged despite substantial scale-up of ART. We evaluated reductions in HIV transmission that may be achieved through early initiation of ART plus partners’ PrEP.MethodsSix intervention scenarios were evaluated in terms of their impact on HIV transmission and their cost-effectiveness for 36 months post-infection. Three scenarios were based on observed data: non-ART, standard-ART, and early-ART. Another three scenarios were based on observed and hypothetical data: non-ART plus partners’ PrEP, standard-ART plus partners’ PrEP, and early-ART plus partners’ PrEP. The number of onward transmissions was calculated according to viral load and self-reported sexual behaviors, and calibrated by the prevalence and incidence of HIV among Chinese MSM. Cost-effectiveness outcomes were quality-adjusted life-years (QALYs) and cost-utility ratio (CUR).ResultsThe estimated number of onward transmissions by every 100 HIV-positive cases 36 months post-infection was 41.83 (95% credible interval: 30.75–57.69) in the non-ART scenario, 7.95 (5.85–10.95) in the early-ART scenario, and 0.79 (0.58–1.09) in the early-ART plus partners’ PrEP scenario. Compared with non-ART, the early-ART and early-ART plus partners’ PrEP scenarios were associated with an 81.0 and 98.1% reduction in HIV transmission, and had a CUR of $12,864/QALY and $16,817/QALY, respectively.ConclusionsIntegrated delivery of early ART and sexual partners’ PrEP could nearly eliminate HIV transmission and reduce costs during the first 36 months of HIV infection. Our results suggest a feasible and cost-effective strategy for reversing the HIV epidemic among MSM in China.
Highlights
Biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus (HIV) infection
According to the timing of ART initiation, 92, 28, and 96 participants were classified as non-ART, standard-ART, and early-ART, and 65, 46, and 86% of each group was retained at the visit 36 months post-infection, respectively
PrEP provision to sexual partners of participants who belonged to the early-ART group with unsuppressed viral load (VL) could nearly eradicate HIV-1 transmission
Summary
Biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus (HIV) infection. China has not released national PrEP guidelines, and HIV incidence among men who have sex with men (MSM) is unchanged despite substantial scale-up of ART. We evaluated reductions in HIV transmission that may be achieved through early initiation of ART plus partners’ PrEP. Several studies have provided crucial evidence that “treatment as prevention” is an effective prevention strategy against human immunodeficiency virus (HIV) infection in men who have sex with men (MSM).
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