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Integrating HIV pre-exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study

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dc.contributor.author Bórquez, Annick
dc.contributor.author Rich, Katherine
dc.contributor.author Farrell, Michael
dc.contributor.author Degenhardt, Louisa
dc.contributor.author McKetin, Rebecca
dc.contributor.author Tran, Lucy T.
dc.contributor.author Cepeda, Javier
dc.contributor.author Silva-Santisteban, Alfonso
dc.contributor.author Konda, Kelika
dc.contributor.author Cáceres, Carlos F.
dc.contributor.author Kelly, Sherrie
dc.contributor.author Altice, Frederick L.
dc.contributor.author Martin, Natasha K.
dc.date.accessioned 2020-07-14T00:00:58Z
dc.date.available 2020-07-14T00:00:58Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8238
dc.description.abstract INTRODUCTION: Among men who have sex with men (MSM) and transgender women (TW), stimulant use is high and has been associated with an increased risk of HIV infection, suicide and cardiovascular disease (CVD) mortality. We used epidemic modelling to investigate these intersecting health harms among MSM/TW in Lima, Peru and assess whether they could be mitigated by prioritizing HIV pre-exposure prophylaxis (PrEP) and harm reduction interventions among MSM/TW who use stimulants. METHODS: We adapted a dynamic model of HIV transmission among MSM/TW in Lima to incorporate stimulant use and increased HIV risk, suicide and CVD mortality. Among 6% to 24% of MSM/TW using stimulants (mostly cocaine), we modelled an increased risk of unprotected anal sex (RR = 1.35 [95%CI: 1.17 to 1.57]) obtained from local data, and increased risk of suicide (SMR = 6.26 [95%CI: 2.84 to 13.80]) and CVD (SMR = 1.83 [95%CI: 0.39 to 8.57]) mortality associated with cocaine use based on a global systematic review. We estimated the proportion of health harms occurring among MSM/TW who use stimulants in the next year (01-2020/01-2021). We also investigated the 10-year impact (01-2020/01-2030) of: (1) PrEP prioritization for stimulant-using MSM/TW compared to random allocation, and (2) integrating PrEP with a theoretical intervention halving stimulant-associated risk. RESULTS: MSM/TW in Lima will experience high HIV incidence, suicide mortality and CVD mortality (1.6/100 py, and 0.018/100 py, 0.13/100 py respectively) in 2020. Despite stimulant using MSM/TW comprising an estimated 9.5% (95%CI: 7.8 to 11.5) of all MSM/TW, in the next year, 11% 95%CI (i.e. 2.5% to 97.5% percentile) 10% to 13%) of new HIV infections, 39% (95%CI: 18% to 60%) of suicides and 15% (95%CI: 3% to 44%) of CVD deaths could occur among this group. Scaling up PrEP among all stimulant using MSM/TW could prevent 19% (95%CI: 11% to 31%) more HIV infections over 10 years compared to random allocation. Integrating PrEP and an intervention to halve stimulant-associated risks could reduce new HIV infections by 20% (95%CI: 10% to 37%), suicide deaths by 14% (95%CI: 5% to 27%) and CVD deaths by 3% (95%CI: 0% to 16%) over a decade. CONCLUSIONS: MSM/TW who use stimulants experience a disproportionate burden of health harms. Prioritizing PrEP based on stimulant use, in addition to sexual behaviour/gender identity criteria, could increase its impact. Integrated substance use, harm reduction, mental health and HIV care among MSM/TW is needed. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartof urn:issn:1758-2652
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject men who have sex with men en_US
dc.subject transgender women en_US
dc.subject HIV pre-exposure prophylaxis en_US
dc.subject modelling en_US
dc.subject stimulants en_US
dc.subject suicide en_US
dc.title Integrating HIV pre-exposure prophylaxis and harm reduction among men who have sex with men and transgender women to address intersecting harms associated with stimulant use: a modelling study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1002/jia2.25495
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE


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