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Potential Impact of Antiretroviral Chemoprophylaxis on HIV-1 Transmission in Resource-Limited Settings

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  • Ume L Abbas
  • Roy M Anderson
  • John W Mellors

Abstract

Background: The potential impact of pre-exposure chemoprophylaxis (PrEP) on heterosexual transmission of HIV-1 infection in resource-limited settings is uncertain. Methodology/Principle Findings: A deterministic mathematical model was used to simulate the effects of antiretroviral PrEP on an HIV-1 epidemic in sub-Saharan Africa under different scenarios (optimistic, neutral and pessimistic) both with and without sexual disinhibition. Sensitivity analyses were used to evaluate the effect of uncertainty in input parameters on model output and included calculation of partial rank correlations and standardized rank regressions. In the scenario without sexual disinhibition after PrEP initiation, key parameters influencing infections prevented were effectiveness of PrEP (partial rank correlation coefficient (PRCC) = 0.94), PrEP discontinuation rate (PRCC = −0.94), level of coverage (PRCC = 0.92), and time to achieve target coverage (PRCC = −0.82). In the scenario with sexual disinhibition, PrEP effectiveness and the extent of sexual disinhibition had the greatest impact on prevention. An optimistic scenario of PrEP with 90% effectiveness and 75% coverage of the general population predicted a 74% decline in cumulative HIV-1 infections after 10 years, and a 28.8% decline with PrEP targeted to the highest risk groups (16% of the population). Even with a 100% increase in at-risk behavior from sexual disinhibition, a beneficial effect (23.4%–62.7% decrease in infections) was seen with 90% effective PrEP across a broad range of coverage (25%–75%). Similar disinhibition led to a rise in infections with lower effectiveness of PrEP (≤50%). Conclusions/Significance: Mathematical modeling supports the potential public health benefit of PrEP. Approximately 2.7 to 3.2 million new HIV-1 infections could be averted in southern sub-Saharan Africa over 10 years by targeting PrEP (having 90% effectiveness) to those at highest behavioral risk and by preventing sexual disinhibition. This benefit could be lost, however, by sexual disinhibition and by high PrEP discontinuation, especially with lower PrEP effectiveness (≤50%).

Suggested Citation

  • Ume L Abbas & Roy M Anderson & John W Mellors, 2007. "Potential Impact of Antiretroviral Chemoprophylaxis on HIV-1 Transmission in Resource-Limited Settings," PLOS ONE, Public Library of Science, vol. 2(9), pages 1-11, September.
    • Handle: RePEc:plo:pone00:0000875
    DOI: 10.1371/journal.pone.0000875
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    Cited by:

    1. Tabassum, Muhammad Farhan & Saeed, Muhammad & Akgül, Ali & Farman, Muhammad & Chaudhry, Nazir Ahmad, 2020. "Treatment of HIV/AIDS epidemic model with vertical transmission by using evolutionary Padé-approximation," Chaos, Solitons & Fractals, Elsevier, vol. 134(C).
    2. Junjun Jiang & Xiaoyi Yang & Li Ye & Bo Zhou & Chuanyi Ning & Jiegang Huang & Bingyu Liang & Xiaoni Zhong & Ailong Huang & Renchuan Tao & Cunwei Cao & Hui Chen & Hao Liang, 2014. "Pre-Exposure Prophylaxis for the Prevention of HIV Infection in High Risk Populations: A Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-8, February.
    3. Yin, Fulian & Jiang, Xinyi & Qian, Xiqing & Xia, Xinyu & Pan, Yanyan & Wu, Jianhong, 2022. "Modeling and quantifying the influence of rumor and counter-rumor on information propagation dynamics," Chaos, Solitons & Fractals, Elsevier, vol. 162(C).
    4. Toxvaerd, Flavio, 2010. "Recurrent Infection and Externalities in Prevention," CEPR Discussion Papers 8112, C.E.P.R. Discussion Papers.
    5. Yin, Fulian & Pang, Hongyu & Xia, Xinyu & Shao, Xueying & Wu, Jianhong, 2021. "COVID-19 information contact and participation analysis and dynamic prediction in the Chinese Sina-microblog," Physica A: Statistical Mechanics and its Applications, Elsevier, vol. 570(C).
    6. Carel Pretorius & John Stover & Lori Bollinger & Nicolas Bacaër & Brian Williams, 2010. "Evaluating the Cost-Effectiveness of Pre-Exposure Prophylaxis (PrEP) and Its Impact on HIV-1 Transmission in South Africa," PLOS ONE, Public Library of Science, vol. 5(11), pages 1-10, November.
    7. Yin, Fulian & Xia, Xinyu & Zhang, Xiaojian & Zhang, Mingjia & Lv, Jiahui & Wu, Jianhong, 2021. "Modelling the dynamic emotional information propagation and guiding the public sentiment in the Chinese Sina-microblog," Applied Mathematics and Computation, Elsevier, vol. 396(C).
    8. Dobromir Dimitrov & Marie-Claude Boily & Elizabeth R Brown & Timothy B Hallett, 2013. "Analytic Review of Modeling Studies of ARV Based PrEP Interventions Reveals Strong Influence of Drug-Resistance Assumptions on the Population-Level Effectiveness," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-9, November.

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