Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States
Year: 2018
Type: article
Abstract: The potential for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States might be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (BMSM and WMSM) in the Atlanta, Georgia, area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could affect HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (hazard ratio = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (hazard ratio = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.
Source: American Journal of Epidemiology
DOI: 10.1093/aje/kwy230
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,856
Funders: Emory University, University of Washington, National Institutes of Health, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Modeling Antiretroviral-Based Prevention among MSM in the US, G1181197472, G2213881162, ENHANCING MODELS OF HIV, VIRAL HEPATITIS, STIS, AND TUBERCULOSIS TO INFORM AND IMPROVE PUBLIC HEALTH IMPACT, G2675028044, G3985073149, G6113675784, G6625095162, Using Sexual Network Transmission Models to Explain HIV Disparities Between Black, G7791962275, G9000034708, G9000186388, STD and AIDS Research Training Grant, University of Washington/Fred Hutch Center for AIDS Research, Demography Center, Center for AIDS Research at Emory University
OpenAlex ID: W2896979063