Preexposure prophylaxis strategies for African–American women affected by mass incarceration
Year: 2020
Type: article
Abstract: OBJECTIVE: We aimed to determine the effectiveness of various preexposure prophylaxis (PrEP) prescription strategies for African-American women impacted by mass incarceration within an urban setting. DESIGN: An agent-based model was utilized to evaluate prevention strategies in an efficient, ethical manner. By defining agents, their characteristics and relationships, we assessed population-level effects of PrEP on HIV incidence. METHODS: We tested hypothetical PrEP prescription strategies within a simulation representing the African-American population of Philadelphia, Pennsylvania. Four strategies were evaluated: PrEP for women meeting CDC indicators regarding partner characteristics, PrEP for women with a recently incarcerated male partner, PrEP for women with a recently released male partner and couples-based PrEP at time of release. Interventions occurred alongside scale-up of HAART. We evaluated reductions in HIV transmissions, the number of persons on PrEP needed to avert one HIV transmission (NNT) and the resulting proportions of people on PrEP. RESULTS: Scenarios prescribing PrEP based on criminal justice system involvement reduced HIV transmissions. The NNT ranged from 147 (couples-based scenario) to 300 (recently released scenario). The percentage of the female population covered by PrEP at any one time ranged from 0.14% (couples-based) to 10.8% (CDC-based). CDC-guideline scenarios were consistently less efficient compared to the justice-involved interventions. CONCLUSION: Expanding PrEP for African-American women and their male partners affected by incarceration should be considered in national HIV prevention goals and correctional facilities leveraged as intervention sites. Partner characteristics in the current CDC indications may be more effective and efficient if guidelines considered criminal justice involvement.
Source: AIDS
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Funders: National Institutes of Health, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Partnerships for the Next Generation of HIV Social Science in South Africa, Preventing HIV Transmission by Recently-Infected Drug Users, PrEP implementation with US HIV-serodiscordant couples: Couples PrEP Demo Project, Using Information to Align Services and Link and Retain Men in the HIV Cascade, Stop-and-Frisk, Arrest, and Incarceration and STI/HIV Risk in Minority MSM, G7662368514, Impact of Mass Incarceration on HIV Acquisition for the Female Partner: An Agent-based Modeling Study of Philadelphia, Highly Adaptive Epidemic Control Strategies for HIV Prevention in Drug Users, Multilevel determinants of HIV pre-exposure prophylaxis (PrEP) utilization and health disparities among Black and Hispanic women, Reinvigorating HIV Prevention and Care for People Who Use Drugs: Accelerating Progress and Sustaining Gains in the Midst of Societal Disruption, Collaborative Justice-Involved Research and Training Program on Substance Use and HIV at Brown University Health, BU Clinical HIV/AIDS Research Training Program (BU-CHART
OpenAlex ID: W3102770768