Can HIV epidemics among men who have sex with men be eliminated through participation in PrEP rollouts?

Sofía Jijón (1) , Jean-Michel Molina (2, 3) , Dominique Costagliola (1) , Virginie Supervie (1) , Romulus Breban (4)

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 Evolution et pathogenèses virales
3 GenCellDis (U944 / UMR7212) - Génomes, biologie cellulaire et thérapeutiques
4 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology

Objectives: To study the conditions under which PrEP coverage can eliminate HIV among men who have sex with men (MSM) in the Paris region. Design: Mathematical modeling. Methods: We propose an innovative approach, combining a transmission model with a game-theoretic model, for decision-making about PrEP use. Individuals at high risk of HIV infection decide to use PrEP, depending on their perceived risk of infection and the relative cost of using PrEP versus antiretroviral treatment (ART), which includes monetary and/or non-monetary aspects, such as price and access model of PrEP, consequences of being infected and lifelong ART. Results: If individuals assessed correctly their infection risk, and the cost of using PrEP were sufficiently low, then the PrEP rollout could lead to elimination. Specifically, assuming 86% PrEP effectiveness, as observed in two clinical trials, a minimum PrEP coverage of 55% (95% CI:43%–64%) among high-risk MSM would achieve elimination in the Paris region. A complete condom drop by MSM using PrEP slightly increases the minimum PrEP coverage required for elimination, by ∼1%, while underestimation of their own HIV infection risk would require PrEP programs reduce the cost of using PrEP by a factor ∼2 to achieve elimination. Conclusions: Elimination conditions are not yet met in the Paris region, where at most 47% of high-risk MSM were using PrEP as of mid-2019. Further lowering the cost of PrEP and promoting a fair perception of HIV risk are required and should be maintained in the long run, to maintain elimination status.

Mots clés: Pre-exposure prophylaxis; HIV; men who have sex with men; behavioral epidemiology; game theory; prevention coverage

Domaines: Maladies infectieuses; Santé publique et épidémiologie

Sofía Jijón, Jean-Michel Molina, Dominique Costagliola, Virginie Supervie, Romulus Breban. Can HIV epidemics among men who have sex with men be eliminated through participation in PrEP rollouts?. AIDS. Official journal of the international AIDS Society, 2021, 35 (14), pp.2347-2354. ⟨10.1097/QAD.0000000000003012⟩. ⟨hal-03287483⟩