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The Effect of PrEP on HIV Incidence Among Men Who Have Sex With Men in the Context of Condom Use, Treatment as Prevention, and Seroadaptive Practices

LeVasseur, Michael, T., PhD, MPH*; Goldstein, Neal, D., PhD, MBI*,†; Tabb, Loni, P., PhD, MS*; Olivieri-Mui, Brianne, L., MPH; Welles, Seth, L., ScD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1, 2018 - Volume 77 - Issue 1 - p 31–40
doi: 10.1097/QAI.0000000000001555
Prevention Research

Background: HIV preexposure prophylaxis (PrEP) is an effective tool in preventing HIV infection among high-risk men who have sex with men (MSM). It is unknown how effective PrEP is in the context of other implemented HIV prevention strategies, including condom use, seroadaption, and treatment as prevention (TasP). We evaluate the impact of increasing uptake of PrEP in conjunction with established prevention strategies on HIV incidence in a high-risk population of MSM through simulation.

Methods: Agent-based simulation models representing the sexual behavior of high-risk, urban MSM in the United States over the period of 1 year were used to evaluate the effect of PrEP on HIV infection rates. Simulations included data for 10,000 MSM and compared increasing rates of PrEP uptake under 8 prevention paradigms: no additional strategies, TasP, condom use, seroadaptive behavior, and combinations thereof.

Results: We observed a mean of 103.2 infections per 10,000 MSM in the absence of any prevention method. PrEP uptake at 25% without any additional prevention strategies prevented 30.7% of infections. In the absence of PrEP, TasP, condom use, and seroadaptive behavior independently prevented 27.1%, 48.8%, and 37.7% of infections, respectively, and together prevented 72.2%. The addition of PrEP to the 3 aforementioned prevention methods, at 25% uptake, prevented an additional 5.0% of infections.

Conclusions: To achieve a 25% reduction in HIV infections by 2020, HIV prevention efforts should focus on significantly scaling up access to PrEP in addition to HIV testing, access to antiretroviral therapy, and promoting condom use.

*Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA;

Department of Pediatrics, Christiana Care Health System, Newark, DE; and

Department of Health Sciences, Bouve School of Health Sciences, Northeastern University, Boston, MA.

Correspondence to: Michael T. LeVasseur, PhD, MPH, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Contributed to the formulation of the research questions, had critical input into interpretation of results and had substantial input into the drafting of the manuscript: M.L., N.G., B.M., L.T., and S.W. Worked on development and programing of the simulation model: M.L., L.T., and N.G.

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Received May 26, 2017

Accepted September 11, 2017

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.