Journal of acquired immune deficiency syndromes (1999) · 2026
Epidemiologic Impact of Prioritizing Long-Acting Injectable Cabotegravir to Men Who Have Sex With Men With Low Pre-Exposure Prophylaxis Use Adherence in the Netherlands: A Mathematical Modeling Study.
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Wang Haoyi, Jonas Kai J, van de Vijver David
Аннотация
BACKGROUND: Long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP), given once every 8 weeks, has been found to have superior efficacy over oral PrEP among men who have sex with men (MSM). We compared the epidemiologic impact of expanding CAB-LA to current oral PrEP users with different levels of adherence, and non-PrEP users among MSM in the Netherlands.
METHODS: An MSM HIV transmission model was calibrated to the Dutch MSM HIV epidemic. The real-world effectiveness of daily oral-PrEP was assumed to decrease by users' adherence levels: High (defined as >75% of the days covered, 93% effectiveness), medium (50%-74% covered, 69%), and low (<50% covered, 18%), respectively. CAB-LA effectiveness was assumed as 91%. CAB-LA was targeted to current oral-PrEP users by their use adherence and non-PrEP-using MSM in 2025. The epidemiologic impact of CAB-LA targeting strategies was evaluated for 5, 15, and 25 years.
RESULTS: Assuming 100% coverage, providing CAB-LA to MSM with low oral PrEP adherence would avert 862 (19.7%) new HIV infections among all MSM for 25 years. Expanding CAB-LA to MSM with medium/high oral PrEP adherence and non-PrEP users did not show a substantial epidemiologic impact. Moreover, our model suggested that the epidemiologic impact would decrease with a lower real-world CAB-LA effectiveness.
CONCLUSIONS: Our model showed that CAB-LA can be an important addition to ending the HIV epidemic by 2030. To optimize the full potential of CAB-LA at the beginning stage of CAB-LA introduction, we suggest prioritizing the transition of current oral PrEP users with low adherence to CAB-LA to reduce HIV transmissions more efficiently.
METHODS: An MSM HIV transmission model was calibrated to the Dutch MSM HIV epidemic. The real-world effectiveness of daily oral-PrEP was assumed to decrease by users' adherence levels: High (defined as >75% of the days covered, 93% effectiveness), medium (50%-74% covered, 69%), and low (<50% covered, 18%), respectively. CAB-LA effectiveness was assumed as 91%. CAB-LA was targeted to current oral-PrEP users by their use adherence and non-PrEP-using MSM in 2025. The epidemiologic impact of CAB-LA targeting strategies was evaluated for 5, 15, and 25 years.
RESULTS: Assuming 100% coverage, providing CAB-LA to MSM with low oral PrEP adherence would avert 862 (19.7%) new HIV infections among all MSM for 25 years. Expanding CAB-LA to MSM with medium/high oral PrEP adherence and non-PrEP users did not show a substantial epidemiologic impact. Moreover, our model suggested that the epidemiologic impact would decrease with a lower real-world CAB-LA effectiveness.
CONCLUSIONS: Our model showed that CAB-LA can be an important addition to ending the HIV epidemic by 2030. To optimize the full potential of CAB-LA at the beginning stage of CAB-LA introduction, we suggest prioritizing the transition of current oral PrEP users with low adherence to CAB-LA to reduce HIV transmissions more efficiently.