title: Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States.
abstract: BACKGROUND
  Preexposure prophylaxis (PrEP) is effective for preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) within trial settings. Population impact will depend on clinical indications for PrEP initiation, coverage levels, and drug adherence. No modeling studies have estimated the impact of clinical practice guidelines for PrEP issued by the Centers for Disease Control and Prevention (CDC).
  
  
  METHODS
  Mathematical models of HIV transmission among MSM were used to estimate the percentage of infections averted (PIA) and the number needed to treat (NNT) under behavioral indications of the CDC's PrEP guidelines. We modeled the contribution of these indications while varying treatment coverage and adherence.
  
  
  RESULTS
  At 40% coverage of indicated MSM over the next decade, application of CDC guidelines would avert 1162 infections per 100 000 person-years, 33.0% of expected infections. The predicted NNT for the guidelines would be 25. Increasing coverage and adherence jointly raise the PIA, but reductions to the NNT were associated with better adherence only.
  
  
  CONCLUSIONS
  Implementation of CDC PrEP guidelines would result in strong and sustained reductions in HIV incidence among MSM in the United States. The guidelines strike a good balance between epidemiological impact (PIA) and efficiency (NNT) at plausible scale-up levels. Adherence counseling could maximize public health investment in PrEP by decreasing the NNT.
authors.affiliation: Department of Epidemiology.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Jenness
authors.affiliation: Department of Anthropology.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Goodreau
authors.affiliation: Department of Epidemiology.
authors.forename: Eli
authors.initials: E
authors.lastname: Rosenberg
authors.affiliation: Center for Studies in Demography and Ecology, University of Washington, Seattle.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Beylerian
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Hoover
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dawn K
authors.initials: DK
authors.lastname: Smith
authors.affiliation: Department of Epidemiology.|Department of Global Health, Emory University.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D065129:Pre-Exposure Prophylaxis; D014481:United States / Q000453:epidemiology
keywords: HIV; clinical guidelines; mathematical model; men who have sex with men; preexposure prophylaxis; sexual network