Potential impact of pre-exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study.
In Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore.



A mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations.



Population attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use.



PrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.
Social and Mathematical Epidemiology Group (SaME), London School of Hygiene and Tropical Medicine, London, UK.|Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Kate.Mitchell@imperial.ac.uk.
Kate M
KM
Mitchell
Social and Mathematical Epidemiology Group (SaME), London School of Hygiene and Tropical Medicine, London, UK.
Holly J
HJ
Prudden
Karnataka Health Promotion Trust, Bangalore, India.|St John's Research Institute, Bangalore, India.
Reynold
R
Washington
Karnataka Health Promotion Trust, Bangalore, India.|Center for Global Public Health (CGPH), University of Manitoba, Winnipeg, Canada.
Shajy
S
Isac
CHARME-India Project, Bangalore, India.
Subramanian P
SP
Rajaram
Social and Mathematical Epidemiology Group (SaME), London School of Hygiene and Tropical Medicine, London, UK.
Anna M
AM
Foss
Social and Mathematical Epidemiology Group (SaME), London School of Hygiene and Tropical Medicine, London, UK.
Fern
F
Terris-Prestholt
Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Marie-Claude
MC
Boily
Social and Mathematical Epidemiology Group (SaME), London School of Hygiene and Tropical Medicine, London, UK.|School of Social and Community Medicine, University of Bristol, Bristol, UK.
Peter
P
Vickerman
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008962:Models, Theoretical; D065129:Pre-Exposure Prophylaxis; D060386:Sex Workers / Q000706:statistics & numerical data
focussed intervention; high-risk group; key population; oral PrEP; prevention; prioritizing; targeting