Table 2.
Predicted Effects of PrEP Policies on Use and Intermediate Health Outcomes Over 20 Years (2017–2036)
| Outcome Mean, % (90% Uncertainty Range; 95% CI)a,b | |||
|---|---|---|---|
| No PrEP | PrEP for AGYW/FSW | PrEP for All | |
| Proportion of women aged 15–24 y on PrEP | 0 | 7.6 (3.4–12.4; 7.3–7.9) | 7.9 (3.5–12.7; 7.6–8.2) |
| Proportion of people aged 15–64 y on PrEP | 0 | 1.3 (0.6–2.0; 1.3–1.3) | 3.4 (1.9–5.4; 3.4–3.4) |
| In 2037, proportion of people aged 15–64 y ever taken PrEP | 0 | 13 (8–17; 13–13) | 31 (23–39; 31–32) |
| Of women aged 15–24 y who have ≥1 new condomless sex partner in a 3-month period, proportion on PrEP | 0 | 37 (28–45; 36–38) | 37 (30–46; 36–38) |
| Number of people on PrEP | 0 | 103 000 (49 000–159 000; 100 000–106 000) | 275 000 (151 000–444 000; 266 000–284 000) |
| Of people on PrEP, percent with (undetected) HIVc | … | 2.7 (1.0–5.1; 2.6–2.8) | 2.1 (0.8–3.4; 2.0–2.2) |
| Of all people living with HIV, percent on ART | 75 (68–80; 75–75) | 76 (70–81; 76–76) | 79 (73–84; 79–79) |
| Of people starting ART, proportion with NNRTI drug resistance | 9 (4–14; 8–9) | 10 (5–16; 10–10) | 14 (8–22; 14–14) |
| Proportion of all people with HIV who have viral load >1000 copies/mL and carry M184V/K65R in majority of virus | 6 (4–8; 6–6) / 4 (2–7; 4–4) | 7 (4–9; 7–7) / 5 (2–7; 5–5) | 8 (5–10; 8–8) / 6 (3–9; 6–6) |
| Of people starting ART, proportion with resistance to at least 1 drug in their 1st-line regimen | 7 (4–10; 7–7) | 11 (7–16; 11–11) | 22 (15–29; 22–22) |
| Of people who started ART 1 y ago and are still on ART, proportion with VL <500 copies/mL | 84 (78–89; 84–84) | 83 (77–89; 82–83) | 81 (75–88; 81–81) |
| Of all people on ART, percent with viral load <1000 copies/mL | 91 (89–94; 91–91) | 91 (89–94; 91–92) | 91 (89–94; 90–91) |
| Of all people living with HIV, percent with viral load <1000 copies/mL | 67 (61–74; 67–68) | 69 (62–75; 69–69) | 71 (66–77; 71–71) |
| Of adult population, proportion with HIV and viral load >1000 copies/mL | 10 (8–13; 10–10) | 10 (7–12; 10–10) | 8 (6–10; 8–8) |
Abbreviations: AGYW, adolescent girls and young women; ART, antiretroviral therapy; CI, confidence interval; FSW, female sex workers; HIV, human immunodeficiency virus; NNRTI, nonnucleoside reverse transcriptase inhibitor; PrEP, preexposure prophylaxis.
aOutcome mean is over 3-month periods 2017–2036, except where stated.
bThe 90% uncertainty range represent variability across scenarios (n = 500) that are consistent with observed data used in calibration (likely largely due to different sexual behavior patterns in different scenarios; they do not include uncertainty over uptake and persistence of PrEP use). The 95% CI represents uncertainty in the mean due to stochastic uncertainty (ie, this tends to zero with increasing number of model runs).
cReasons for HIV infection in people on PrEP are (in order of importance): infection on PrEP with drug-resistant HIV; infection on PrEP with drug-sensitive HIV due to fact that efficacy is 95% and not 100%; starting PrEP in primary infection; and starting PrEP while HIV positive due to <100% sensitivity of HIV test.