title: Modeling dynamic interactions between pre-exposure prophylaxis interventions & treatment programs: predicting HIV transmission & resistance.
abstract: Clinical trials have recently demonstrated the effectiveness of Pre-Exposure Prophylaxis (PrEP) in preventing HIV infection. Consequently, PrEP may soon be used for epidemic control. We model the dynamic interactions that will occur between treatment programs and potential PrEP interventions in resource-constrained countries. We determine the consequences for HIV transmission and drug resistance. We use response hypersurface modeling to predict the effect of PrEP on decreasing transmission as a function of effectiveness, adherence and coverage. We predict PrEP will increase need for second-line therapies (SLT) for treatment-naïve individuals, but could significantly decrease need for SLT for treatment-experienced individuals. If the rollout of PrEP is carefully planned it could increase the sustainability of treatment programs. If not, need for SLT could increase and the sustainability of treatment programs could be compromised. Our results show the optimal strategy for rolling out PrEP in resource-constrained countries is to begin around the "worst" treatment programs.
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California. USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Supervie
authors.forename: Meagan
authors.initials: M
authors.lastname: Barrett
authors.forename: James S
authors.initials: JS
authors.lastname: Kahn
authors.forename: Godfrey
authors.initials: G
authors.lastname: Musuka
authors.forename: Themba Lebogang
authors.initials: TL
authors.lastname: Moeti
authors.forename: Lesego
authors.initials: L
authors.lastname: Busang
authors.forename: Lesogo
authors.initials: L
authors.lastname: Busang
authors.forename: Sally
authors.initials: S
authors.lastname: Blower
mesh_terms: D000293:Adolescent; D000328:Adult; D001902:Botswana / Q000453:epidemiology; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009154:Mutation; D015995:Prevalence; D012680:Sensitivity and Specificity; D013499:Surface Properties; D035501:Uncertainty; D055815:Young Adult