Table 2. Alternative programmes compared.
Reference | Base Comparison Scenario | PrEP Intervention | ||
PrEP Regimen | Prioritisation | Coverage | ||
Generalised epidemics in southern Africa | ||||
Abbas [25] | No PrEP. ART was not modelled. | Once daily oral dosing | No prioritisation: general population. By sexual activity: two highest sexual activity groups prioritised. By age: 15–20 y group prioritised. | Percent of the population using PrEP: Optimistic scenario, 75%; Neutral scenario, 50%; Pessimistic scenario, 25% |
Pretorius [30] | No PrEP. ART coverage expands at its current rate. ART efficacy: 90% reduction in transmission probability. | Once daily oral dosing | No prioritisation: 15–35 y; By age: 15–25 y, or 25–35 y | Percent of women using PrEP: 20%, dropout rate:1.5% |
Hallett [28] | No PrEP. ART initiation for the infected partner when CD4 cell count fell below 200 cells/ml. In a separate scenario, expansion of eligibility criteria for ART initiation was included (below 350 CD4 cells/ml). | Once daily oral dosing | No prioritisation: Always use PrEP after diagnosis partner. By timing: Up to partner's ART init; up to partner's ART init+1 y; during conception/pregnancya | Percent of the population using PrEP: see prioritisation |
Williams [32] | No PrEP. The scale-up of ARV therapy was not modelled. | Vaginal gel, two doses pericoitally | PrEP used only by women | Percent of sex acts protected: High: 90%, Medium: 50%, Low: 25% |
Walensky [31] | No PrEP. Patients identified as HIV infected received ART as per guidelines. | Vaginal gel, two doses pericoitally | PrEP used only by women. By age: ≤25 y (high inc. group) | Cohort-wide PrEP use continues until HIV infection or death. |
Alistar [37] | No PrEP. 40% HIV infected patients received ART as per guidelines. ART efficacy: 95% reduction in transmission probability. | Once daily oral dosing | No prioritisation: general use; By sexual activity: groups of high number of partners and low condom use | Rate of recruitment into the program: 25%, 50%, 75%, 100%. Included a rate of dropout from PrEP. |
Cremin [36] | ART efficacy: 96% reduction in transmission probability. Baseline scenarios varied: from status quo with current scale-up of ART to counterfactual including MC and ART scale-up. All scenarios included a 7/100 PY dropout rate while on ART. | Once daily oral dosing | No prioritisation: 15–54 y; By age: 15–24 y | Percent of the population group using PrEP: 40%, 80% |
Concentrated epidemics among MSM in high-income countries | ||||
Desai [26] | No PrEP. The scale-up of ARV therapy was not modelled. | Once daily oral dosing | No prioritisation—results not shown. Results for scenarios targeting high risk MSM only. | 25% high riskb; (5.2% of all MSM)c; Discontinuation rate: 40% per year |
Paltiel [34] | No PrEP. Patients identified as HIV infected received ART as per guidelines. | Once daily oral dosing | No prioritisation: all MSM. By age: <20 y. | Cohort-wide PrEP use continues until HIV infection or death. |
Koppenhaver [29] | No PrEP. 25% of susceptible and undiagnosed MSM are tested per year, if eligible they start ART as per guidelines. | Once daily oral dosing | No prioritisation: all MSM. | 100% |
Juusola [35] | No PrEP. Patients identified as HIV infected received ART as per guidelines. | Once daily oral dosing | No prioritisation: all MSM; By sexual activity: high risk MSM. | 100%, 50%, 20% of all MSM or those at high riskd |
Concentrated epidemics among MSM in low- and middle-income countries | ||||
Gomez [27] | No PrEP. Patients identified as HIV infected received ART as per guidelines (CD4<200 cells/ml) to achieve 40% coverage. | Once daily oral dosing | No prioritisation: uniform coverage. By sexual activity: some and high prioritisation. | Low 5%; High 20% |
Concentrated epidemics among PWID in low- and middle-income countries | ||||
Alistar [33] | No PrEP. Limited coverage of MMT and ART. | Once daily oral dosing | No prioritisation: all PWID: in all cases, MMT and PrEP are given only to PWID. | 25%, 50% uninfected PWID. Included a rate of dropout from PrEP. |
Period trying to conceive and while pregnant.
The authors also considered a scenario of 2.5% coverage, but explored results for the 25% scenario.
Defined as those with more than five partners per y.
Coverage includes only people fully adherent to PrEP.
init, initiation; MC, male circumcision; MMT, methadone maintenance treatment; n/a, not applicable.