Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States
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...
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| Veröffentlicht in: | American journal of epidemiology 2019-04, Vol.188 (4), p.743-752 |
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| container_title | American journal of epidemiology |
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| creator | Jenness, Samuel M Maloney, Kevin M Smith, Dawn K Hoover, Karen W Goodreau, Steven M Rosenberg, Eli S Weiss, Kevin M Liu, Albert Y Rao, Darcy W Sullivan, Patrick S |
| description | 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. |
| doi_str_mv | 10.1093/aje/kwy230 |
| format | Article |
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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.</description><identifier>ISSN: 0002-9262</identifier><identifier>EISSN: 1476-6256</identifier><identifier>DOI: 10.1093/aje/kwy230</identifier><identifier>PMID: 30312365</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject><![CDATA[Adult ; Anti-HIV Agents - therapeutic use ; Black or African American - statistics & numerical data ; Disease transmission ; Gays & lesbians ; Georgia - epidemiology ; Health Status Disparities ; HIV ; HIV Infections - epidemiology ; HIV Infections - ethnology ; HIV Infections - prevention & control ; Homosexuality, Male - ethnology ; Homosexuality, Male - statistics & numerical data ; Human immunodeficiency virus ; Humans ; Incidence ; Male ; Mathematical models ; Mens health ; Parameter estimation ; Practice of Epidemiology ; Pre-Exposure Prophylaxis - statistics & numerical data ; Prophylaxis ; Racial differences ; Sexual and Gender Minorities - statistics & numerical data ; Sexually transmitted diseases ; STD ; United States ; Viruses ; White People - statistics & numerical data ; Young Adult]]></subject><ispartof>American journal of epidemiology, 2019-04, Vol.188 (4), p.743-752</ispartof><rights>Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2019. 2019</rights><rights>Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2019.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-cc3d07d7068dd9025c524c5730fc87f92d46d05a934c6de9ef3b07f6faeb59f93</citedby><cites>FETCH-LOGICAL-c436t-cc3d07d7068dd9025c524c5730fc87f92d46d05a934c6de9ef3b07f6faeb59f93</cites><orcidid>0000-0003-4577-7406</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30312365$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jenness, Samuel M</creatorcontrib><creatorcontrib>Maloney, Kevin M</creatorcontrib><creatorcontrib>Smith, Dawn K</creatorcontrib><creatorcontrib>Hoover, Karen W</creatorcontrib><creatorcontrib>Goodreau, Steven M</creatorcontrib><creatorcontrib>Rosenberg, Eli S</creatorcontrib><creatorcontrib>Weiss, Kevin M</creatorcontrib><creatorcontrib>Liu, Albert Y</creatorcontrib><creatorcontrib>Rao, Darcy W</creatorcontrib><creatorcontrib>Sullivan, Patrick S</creatorcontrib><title>Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States</title><title>American journal of epidemiology</title><addtitle>Am J Epidemiol</addtitle><description>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.</description><subject>Adult</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Black or African American - statistics & numerical data</subject><subject>Disease transmission</subject><subject>Gays & lesbians</subject><subject>Georgia - epidemiology</subject><subject>Health Status Disparities</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - ethnology</subject><subject>HIV Infections - prevention & control</subject><subject>Homosexuality, Male - ethnology</subject><subject>Homosexuality, Male - statistics & numerical data</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Mens health</subject><subject>Parameter estimation</subject><subject>Practice of Epidemiology</subject><subject>Pre-Exposure Prophylaxis - statistics & numerical data</subject><subject>Prophylaxis</subject><subject>Racial differences</subject><subject>Sexual and Gender Minorities - statistics & numerical data</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>United States</subject><subject>Viruses</subject><subject>White People - statistics & numerical data</subject><subject>Young Adult</subject><issn>0002-9262</issn><issn>1476-6256</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kV1rFDEUhoModrt64w-QgAhSGJvJ12xuCmW17UJB6Ye3IZuc6WadnYxJpu3-eyNbF_XCq4STh4f35EXoTU0-1kSxY7OG4-8PW8rIMzSpeSMrSYV8jiaEEFopKukBOkxpTUhdK0FeogNGWE2ZFBN0f-pchJR8f4fPzZCw7_HF4hv-GgEeh5DGCOUehtW2M48-4bkpgxzwFbjRAr4y1psOf_JpMNFnD3vBorfeQV-YMsgrwLe9z-DwdTYZ0iv0ojVdgtdP5xTdnn2-mV9Ul1_OF_PTy8pyJnNlLXOkcQ2RM-cUocIKyq1oGGntrGkVdVw6Ioxi3EoHClq2JE0rWwNLoVrFpuhk5x3G5QachT5H0-kh-o2JWx2M13-_9H6l78K9lpzNZrUogg9Pghh-jJCy3vhkoetMD2FMmpYvVYxywQv67h90HcbYl_V0qUZSrkhJPkVHO8rGkFKEdh-mJvpXnbrUqXd1Fvjtn_H36O_-CvB-B4Rx-J_oJ6nBqac</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Jenness, Samuel M</creator><creator>Maloney, Kevin M</creator><creator>Smith, Dawn K</creator><creator>Hoover, Karen W</creator><creator>Goodreau, Steven M</creator><creator>Rosenberg, Eli S</creator><creator>Weiss, Kevin M</creator><creator>Liu, Albert Y</creator><creator>Rao, Darcy W</creator><creator>Sullivan, Patrick S</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4577-7406</orcidid></search><sort><creationdate>20190401</creationdate><title>Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States</title><author>Jenness, Samuel M ; 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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.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>30312365</pmid><doi>10.1093/aje/kwy230</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-4577-7406</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Anti-HIV Agents - therapeutic use Black or African American - statistics & numerical data Disease transmission Gays & lesbians Georgia - epidemiology Health Status Disparities HIV HIV Infections - epidemiology HIV Infections - ethnology HIV Infections - prevention & control Homosexuality, Male - ethnology Homosexuality, Male - statistics & numerical data Human immunodeficiency virus Humans Incidence Male Mathematical models Mens health Parameter estimation Practice of Epidemiology Pre-Exposure Prophylaxis - statistics & numerical data Prophylaxis Racial differences Sexual and Gender Minorities - statistics & numerical data Sexually transmitted diseases STD United States Viruses White People - statistics & numerical data Young Adult |
| title | Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States |
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