Incidence of Gonorrhea and Chlamydia Following Human Immunodeficiency Virus Preexposure Prophylaxis Among Men Who Have Sex With Men: A Modeling Study

Preexposure prophylaxis (PrEP) is highly effective for preventing human immunodeficiency virus (HIV) infection, but risk compensation (RC) in men who have sex with men (MSM) raises concerns about increased sexually transmitted infections (STIs). The Center for Disease Control and Prevention's (...

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Published in:	Clinical infectious diseases Vol. 65; no. 5; p. 712
Main Authors:	Jenness, Samuel M, Weiss, Kevin M, Goodreau, Steven M, Gift, Thomas, Chesson, Harrell, Hoover, Karen W, Smith, Dawn K, Liu, Albert Y, Sullivan, Patrick S, Rosenberg, Eli S
Format:	Journal Article
Language:	English
Published:	United States 01.09.2017
Subjects:	Chlamydia Infections - epidemiology Cohort Studies Gonorrhea - epidemiology HIV Infections - epidemiology HIV Infections - prevention & control Homosexuality, Male Humans Male Models, Statistical Pre-Exposure Prophylaxis - methods Pre-Exposure Prophylaxis - statistics & numerical data mathematical model Chlamydia trachomatis Neisseria gonorrhoeae preexposure prophylaxis men who have sex with men
ISSN:	1537-6591, 1537-6591
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Abstract	Preexposure prophylaxis (PrEP) is highly effective for preventing human immunodeficiency virus (HIV) infection, but risk compensation (RC) in men who have sex with men (MSM) raises concerns about increased sexually transmitted infections (STIs). The Center for Disease Control and Prevention's (CDC's) PrEP guidelines recommend biannual STI screening, which may reduce incidence by treating STIs that would otherwise remain undiagnosed. We investigated these two counteracting phenomena. With a network-based mathematical model of HIV, Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) transmission dynamics among MSM in the United States, we simulated PrEP uptake following the prescription indications and HIV/STI screening recommendations in the CDC guidelines. Scenarios varied PrEP coverage (the proportion of MSM indicated for PrEP who received it), RC (a reduction in the per-act probability of condom use), and the STI screening interval. In our reference scenario (40% coverage, 40% RC), 42% of NG and 40% of CT infections would be averted over the next decade. A doubling of RC would still result in net STI prevention relative to no PrEP. STIs declined because PrEP-related STI screening resulted in a 17% and 16% absolute increase in the treatment of asymptomatic and rectal STIs, respectively. Screening and timely treatment at quarterly vs biannual intervals would reduce STI incidence an additional 50%. Implementation of the CDC PrEP guidelines while scaling up PrEP coverage could result in a significant decline in STI incidence among MSM. Our study highlights the design of PrEP not only as antiretroviral medication but as combination HIV/STI prevention incorporating STI screening.
AbstractList	Preexposure prophylaxis (PrEP) is highly effective for preventing human immunodeficiency virus (HIV) infection, but risk compensation (RC) in men who have sex with men (MSM) raises concerns about increased sexually transmitted infections (STIs). The Center for Disease Control and Prevention's (CDC's) PrEP guidelines recommend biannual STI screening, which may reduce incidence by treating STIs that would otherwise remain undiagnosed. We investigated these two counteracting phenomena.BackgroundPreexposure prophylaxis (PrEP) is highly effective for preventing human immunodeficiency virus (HIV) infection, but risk compensation (RC) in men who have sex with men (MSM) raises concerns about increased sexually transmitted infections (STIs). The Center for Disease Control and Prevention's (CDC's) PrEP guidelines recommend biannual STI screening, which may reduce incidence by treating STIs that would otherwise remain undiagnosed. We investigated these two counteracting phenomena.With a network-based mathematical model of HIV, Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) transmission dynamics among MSM in the United States, we simulated PrEP uptake following the prescription indications and HIV/STI screening recommendations in the CDC guidelines. Scenarios varied PrEP coverage (the proportion of MSM indicated for PrEP who received it), RC (a reduction in the per-act probability of condom use), and the STI screening interval.MethodsWith a network-based mathematical model of HIV, Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) transmission dynamics among MSM in the United States, we simulated PrEP uptake following the prescription indications and HIV/STI screening recommendations in the CDC guidelines. Scenarios varied PrEP coverage (the proportion of MSM indicated for PrEP who received it), RC (a reduction in the per-act probability of condom use), and the STI screening interval.In our reference scenario (40% coverage, 40% RC), 42% of NG and 40% of CT infections would be averted over the next decade. A doubling of RC would still result in net STI prevention relative to no PrEP. STIs declined because PrEP-related STI screening resulted in a 17% and 16% absolute increase in the treatment of asymptomatic and rectal STIs, respectively. Screening and timely treatment at quarterly vs biannual intervals would reduce STI incidence an additional 50%.ResultsIn our reference scenario (40% coverage, 40% RC), 42% of NG and 40% of CT infections would be averted over the next decade. A doubling of RC would still result in net STI prevention relative to no PrEP. STIs declined because PrEP-related STI screening resulted in a 17% and 16% absolute increase in the treatment of asymptomatic and rectal STIs, respectively. Screening and timely treatment at quarterly vs biannual intervals would reduce STI incidence an additional 50%.Implementation of the CDC PrEP guidelines while scaling up PrEP coverage could result in a significant decline in STI incidence among MSM. Our study highlights the design of PrEP not only as antiretroviral medication but as combination HIV/STI prevention incorporating STI screening.ConclusionsImplementation of the CDC PrEP guidelines while scaling up PrEP coverage could result in a significant decline in STI incidence among MSM. Our study highlights the design of PrEP not only as antiretroviral medication but as combination HIV/STI prevention incorporating STI screening. Preexposure prophylaxis (PrEP) is highly effective for preventing human immunodeficiency virus (HIV) infection, but risk compensation (RC) in men who have sex with men (MSM) raises concerns about increased sexually transmitted infections (STIs). The Center for Disease Control and Prevention's (CDC's) PrEP guidelines recommend biannual STI screening, which may reduce incidence by treating STIs that would otherwise remain undiagnosed. We investigated these two counteracting phenomena. With a network-based mathematical model of HIV, Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) transmission dynamics among MSM in the United States, we simulated PrEP uptake following the prescription indications and HIV/STI screening recommendations in the CDC guidelines. Scenarios varied PrEP coverage (the proportion of MSM indicated for PrEP who received it), RC (a reduction in the per-act probability of condom use), and the STI screening interval. In our reference scenario (40% coverage, 40% RC), 42% of NG and 40% of CT infections would be averted over the next decade. A doubling of RC would still result in net STI prevention relative to no PrEP. STIs declined because PrEP-related STI screening resulted in a 17% and 16% absolute increase in the treatment of asymptomatic and rectal STIs, respectively. Screening and timely treatment at quarterly vs biannual intervals would reduce STI incidence an additional 50%. Implementation of the CDC PrEP guidelines while scaling up PrEP coverage could result in a significant decline in STI incidence among MSM. Our study highlights the design of PrEP not only as antiretroviral medication but as combination HIV/STI prevention incorporating STI screening.
Author	Sullivan, Patrick S Weiss, Kevin M Rosenberg, Eli S Chesson, Harrell Hoover, Karen W Goodreau, Steven M Smith, Dawn K Liu, Albert Y Jenness, Samuel M Gift, Thomas
Author_xml	– sequence: 1 givenname: Samuel M surname: Jenness fullname: Jenness, Samuel M organization: Department of Epidemiology, Emory University, Atlanta, Georgia – sequence: 2 givenname: Kevin M surname: Weiss fullname: Weiss, Kevin M organization: Department of Epidemiology, Emory University, Atlanta, Georgia – sequence: 3 givenname: Steven M surname: Goodreau fullname: Goodreau, Steven M organization: Department of Anthropology, University of Washington, Seattle – sequence: 4 givenname: Thomas surname: Gift fullname: Gift, Thomas organization: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 5 givenname: Harrell surname: Chesson fullname: Chesson, Harrell organization: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 6 givenname: Karen W surname: Hoover fullname: Hoover, Karen W organization: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 7 givenname: Dawn K surname: Smith fullname: Smith, Dawn K organization: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 8 givenname: Albert Y surname: Liu fullname: Liu, Albert Y organization: San Francisco Department of Public Health, California – sequence: 9 givenname: Patrick S surname: Sullivan fullname: Sullivan, Patrick S organization: Department of Epidemiology, Emory University, Atlanta, Georgia – sequence: 10 givenname: Eli S surname: Rosenberg fullname: Rosenberg, Eli S organization: Department of Epidemiology, Emory University, Atlanta, Georgia
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SubjectTerms	Chlamydia Infections - epidemiology Cohort Studies Gonorrhea - epidemiology HIV Infections - epidemiology HIV Infections - prevention & control Homosexuality, Male Humans Male Models, Statistical Pre-Exposure Prophylaxis - methods Pre-Exposure Prophylaxis - statistics & numerical data
Title	Incidence of Gonorrhea and Chlamydia Following Human Immunodeficiency Virus Preexposure Prophylaxis Among Men Who Have Sex With Men: A Modeling Study
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