Advertisement
Research Article

The Potential Impact of Pre-Exposure Prophylaxis for HIV Prevention among Men Who Have Sex with Men and Transwomen in Lima, Peru: A Mathematical Modelling Study

  • Gabriela B. Gomez equal contributor,

    equal contributor Contributed equally to this work with: Gabriela B. Gomez, Annick Borquez

    Affiliations: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands

    X
  • Annick Borquez equal contributor mail,

    equal contributor Contributed equally to this work with: Gabriela B. Gomez, Annick Borquez

    annick.borquez06@imperial.ac.uk

    Affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom

    X
  • Carlos F. Caceres,

    Affiliations: Instituto de Estudios en Salud, Sexualidad y Desarrollo Humano, Lima, Peru, Universidad Peruana Cayetano Heredia, Lima, Peru

    X
  • Eddy R. Segura,

    Affiliation: Universidad Peruana Cayetano Heredia, Lima, Peru

    X
  • Robert M. Grant,

    Affiliation: Gladstone Institutes, University of California at San Francisco, San Francisco, California, United States of America

    X
  • Geoff P. Garnett,

    Affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom

    X
  • Timothy B. Hallett

    Affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, United Kingdom

    X
  • Published: October 09, 2012
  • DOI: 10.1371/journal.pmed.1001323

Reader Comments (1)

Post a new comment on this article

Safer sex...

Posted by guscairns on 11 Oct 2012 at 14:02 GMT

These findings suggest that under some circumstances, PrEP could be a cost-effective tool to reduce new HIV infections. However, as the researchers discuss, PrEP is expensive and only partly effective. Moreover, its effectiveness depends on two behavioral factors—adherence to a strict drug regimen and continued practicing of safe sex—both of which remain hard to predict.
http://plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001323#article1.front1.article-meta1.abstract3.sec4.p1

Just one comment: This study certainly shows that adherence to a strict drug regimen is likely to be crucial to the impact of PrEP, but interestingly, it does not find that continued practicing of safe sex is crucial, or only to a surprisingly limited extent. Under the low-coverage, highly-targeted scenario, PrEP would remain cost effective if condom use fell by 30% and probably cost effective if it halved; and, as the authors say, the adoption of PrEP would only lead to an increase in HIV incidence if condom use was abandoned and PrEP was only 44% efficacious. Although we hope risk behaviour will not rise, not least because it will cause other STI-related morbidity, it is not the most or second-most important limiting factor on the likely effectiveness of PrEP.

No competing interests declared.