The impact of combinations of strategies for HIV prevention among men who have sex with men

The impact of combinations of strategies for HIV prevention among men who have sex with men

Project

In the Netherlands, men who have sex with men (MSM) account for the largest fraction of new HIV diagnoses annually. Despite the availability of successful treatment, there is still ongoing transmission. Attention has focused recently on the following strategies: test and treat (TT), partner notification (PN), and pre-exposure prophylaxis (PrEP). The joint impact of combined strategies may be greater than that of each strategy alone, but strategies may affect each other's impact. Therefore, it is crucial to gain insights in the possible synergy or antagonism of TT, PN, and PrEP in order to optimize the allocation of resources into the most effective combinations of the three strategies and before enormous efforts and resources are consumed on conflicting strategies. To do that, we will investigate the individual and combined impact of TT, PN, and PrEP on HIV/STI transmission and assess their cost-effectiveness. We will develop an individual-based transmission model for HIV and other STIs and calibrate the model to empirical data. Results from the transmission model will be used in an economic model that includes quality-adjusted life-years (QALY) and costs for each strategy. The strategies will be compared in terms of prevented HIV infections, QALY gains, incurred costs, and cost-effectiveness ratios.

Project details

Time frame
13 December 2014 - 30 September 2019
Budget
€ 249,626
Active in
Netherlands

Objectives

This project will assess the integrated impact of combinations of strategies for HIV prevention among MSM in the Netherlands.
We will develop an individual-based transmission model for HIV and other STIs and calibrate the model to empirical data. Results from the transmission model will be used in an economic model that will gain insight in which strategy or combination of strategies would be most effective.
Specifically, the following questions will be addressed:
1) What could be the individual impact of TT, PN, and PrEP on HIV incidence? Which regimens of these strategies are most effective in reducing HIV incidence?
2) How do these strategies affect each other's impact and what is their combined impact?
3) How could TT, PN, and PrEP affect the transmission of other STIs?
4) Under what conditions could PrEP or TT result in increases in drug-resistant HIV?
5) Is PrEP, TT, or PN cost-effective? Which combinations of these strategies are more cost-effective?
Output will be:
Presentations at (inter)national conferences.
#• PhD thesis.
#• Policy tool: well-documented software for modelling HIV and STI transmission and the impact of interventions. The software can be extended in the future for other interventions, for heterosexual transmission, or other STIs (HPV, HBV, CV).
#• Internet site with links to publications, webcasts of presentations, documentation for the models, information on participating experts and organizations, links to funding organizations.
#• International workshop, with the participation of WHO and ECDC, to inform about the findings of the study and initiate collaborations with other countries on the impact of TT, PN, and PrEP.
#• The results will be used for public health policy advice (guidelines for PrEP and ART use, promotion of HIV testing, PN tools) and the allocation of financial resources.

Community groups

policy makers
scientific community

Background

In the Netherlands, men who have sex with men (MSM) account for the largest fraction of new HIV diagnoses annually. Despite the availability of successful treatment, there is still ongoing transmission

Attention has focused recently on the following strategies: test and treat (TT), partner notification (PN), and pre-exposure prophylaxis (PrEP). The joint impact of combined strategies may be greater than that of each strategy alone, but strategies may affect each other's impact. Therefore, it is crucial to gain insights in the possible synergy or antagonism of TT, PN, and PrEP in order to optimize the allocation of resources into the most effective combinations of the three strategies and before enormous efforts and resources are consumed on conflicting strategies.

Goals

Radical reduction in the Big Six STIs and 0 new HIV infections
100%
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