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Impact of providing pre-exposure prophylaxis for HIV at clinics for sexually transmitted infections in Baltimore City

an agent-based model

Kasaie, Parastu, PhD1; Berry, Stephen A., MD2; Shah, Maunank S., MD, PhD2; Rosenberg, Eli S., PhD3; Hoover, Karen W., MD, MPH4; Gift, Thomas L., PhD5; Chesson, Harrell, PhD5; Pennington, Jeff, BS1; German, Danielle, PhD1; Flynn, Colin P., ScM6; Beyrer, Chris, MD, PhD1; Dowdy, David W., MD, PHD1

doi: 10.1097/OLQ.0000000000000882
Original Study: PDF Only

Background Pre-exposure prophylaxis (PrEP) greatly reduces the risk of HIV acquisition, but its optimal delivery strategy remains uncertain. Clinics for sexually transmitted infections (STIs) can provide an efficient venue for PrEP delivery.

Methods To quantify the added value of STI clinic–based PrEP delivery, we used an agent-based simulation of HIV transmission among men who have sex with men (MSM). We simulated the impact of PrEP delivery through STI clinics compared with PrEP delivery in other community-based settings. Our primary outcome was the projected twenty-year reduction in HIV incidence among MSM.

Results Assuming PrEP uptake and adherence of 60% each, evaluating STI clinic attendees and delivering PrEP to eligible MSM reduced HIV incidence by 16% [95% uncertainty range: 14% – 18%] over 20 years, an impact that was 1.8 [1.7–2.0] times as great as that achieved by evaluating an equal number of MSM recruited from the community. Comparing strategies where an equal number of MSM received PrEP in each strategy (i.e., evaluating more individuals for PrEP in the community-based strategy, since MSM attending STI clinics are more likely to be PrEP eligible), the reduction in HIV incidence under the STI clinic-based strategy was 1.3 [1.3–1.4] times as great as that of community-based delivery.

Conclusions Delivering PrEP to MSM who attend STI clinics can improve efficiency and effectiveness. If high levels of adherence can be achieved in this population, STI clinics may be an important venue for PrEP implementation.

1 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA 21205

2 School of Medicine, Johns Hopkins University, Baltimore, MD, USA 21205

3 Rollins School of Public Health, Emory University, Atlanta, GA, USA

4 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

5 Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC

6 Maryaland Department of Health and Mental Hygiene, Baltimore, MD, USA, 21201

Corresponding Author: David W. Dowdy (, 615 N. Wolfe Street, Room E6531, Baltimore, Maryland 21205, Phone: 410-614-5022; Fax: 410-614-0902

Conflict of interest: All authors report no potential conflicts of interest.

Funding: This work was supported by U.S. Centers for Disease Control and Prevention (Enhancing Models of HIV, Viral Hepatitis, STIs, and Tuberculosis to Inform and Improve Public Health Impact, U38PS004646) – [PK, MSS, ESR, JP, DWD]

This work was supported by Johns Hopkins University Center for AIDS Research (P30AI094189) – [PK]

Disclaimer: The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Center for Disease Control and Prevention.

Received for publication December 15, 2017, and accepted June 20, 2018.

© Copyright 2018 American Sexually Transmitted Diseases Association