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THP 74 Decreasing HIV Incidence Among MSM in Baltimore City Via Targeted PrEP Provision at STI Clinics

Thursday, September 22, 2016
Galleria Exhibit Hall
Parastu Kasaie, PhD1, Stephen Berry, MD2, Maunank Shah, MD2, Eli Rosenberg, PhD3, Karen W. Hoover, MD, MPH4, Jeff Pennington, -2, Danielle German, PhD2, Colin Flynn, ScM5, Chris Beyrer, MD2 and David Dowdy, MD, PhD2, 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University, 3Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 4Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, 5Maryland Department of Health & Mental Hygiene

Background: Pre-exposure prophylaxis (PrEP) is a proven strategy to reduce the risk of HIV acquisition, but the optimal delivery strategy for PrEP remains uncertain. Providing PrEP at clinics for sexually transmitted infections (STIs) may improve the efficiency of screening for PrEP eligibility and also target the highest-risk individuals, but the added value of STI clinic-based PrEP delivery remains uncertain.

Methods: We expanded an agent-based simulation of HIV transmission among men who have sex with men (MSM) in Baltimore city. We include a novel STI clinic module and evaluate the potential impact of a PrEP delivery strategy that uses these clinic visits as an entry point. We then estimate the efficiency of STI clinic-based PrEP by comparing the impact of this strategy to that of an untargeted PrEP delivery strategy (i.e., delivered to random MSM in the population). Our primary outcome was the five-year reduction in HIV incidence achievable under each strategy.

Results: Assuming equal (and high) proportions of PrEP coverage and adherence in the two strategies, PrEP delivery through STI-clinics achieved 3.73 [interquartile range [IQR] of simulations: 1.3-3.72] times greater impact on HIV incidence than random evaluation of an equal number of MSM for PrEP – reflecting both STI clinic attendees’ higher likelihood to be PrEP-eligible and their higher sexual frequency.  Comparing strategies where an equal number of MSM were started on PrEP over five years in each strategy (i.e., evaluating more individuals for PrEP in the random strategy), the five-year reduction in HIV incidence was 2.29 [IQR: 1.02-2.04] times greater if those MSM were recruited from STI clinics rather than randomly from the general population.

Conclusions: STI clinics improve the efficiency and effectiveness of PrEP delivery relative to random selection of MSM for PrEP. If high levels of adherence can be achieved, STI clinics may be a highly effective venue for PrEP implementation.

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