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dc.contributor.authorRozhnova, Ganna
dc.contributor.authorHeijne, Janneke C M
dc.contributor.authorBasten, Maartje
dc.contributor.authorden Daas, Chantal
dc.contributor.authorMatser, Amy
dc.contributor.authorKretzschmar, Mirjam
dc.date.accessioned2019-07-30T10:01:46Z
dc.date.available2019-07-30T10:01:46Z
dc.date.issued2019-03-14
dc.identifier.issn1878-0067
dc.identifier.pmid31126778
dc.identifier.doi10.1016/j.epidem.2019.03.003
dc.identifier.urihttp://hdl.handle.net/10029/623187
dc.description.abstractChanges in sexual risk behavior over the life course in men who have sex with men (MSM) can influence population-level intervention efficacy. Our objective was to investigate the impact of incorporating sexual trajectories describing long-term changes in risk levels on the reduction in HIV prevalence by pre-exposure prophylaxis (PrEP) among MSM. Based on the Amsterdam Cohort Study data, we developed two models of HIV transmission in a population stratified by sexual behavior. In the first model, individuals were stratified into low, medium and high risk levels and did not change their risk levels. The second model had the same stratification but incorporated additionally three types of sexual behavior trajectories. The models assumed universal antiretroviral treatment of HIV+ MSM, and PrEP use by high risk HIV- MSM. We computed the relative reduction in HIV prevalence in both models for annual PrEP uptakes of 10% to 80% at different time points after PrEP introduction. We then investigated the impact of sexual trajectories on the effectiveness of PrEP intervention. The impact of sexual trajectories on the overall prevalence and prevalence in individuals at low, medium and high risk levels varied with PrEP uptake and time after PrEP introduction. Compared to the model without sexual trajectories, the model with trajectories predicted a higher impact of PrEP on the overall prevalence, and on the prevalence among the medium and high risk individuals. In low risk individuals, there was more reduction in prevalence during the first 15 years of PrEP intervention if sexual trajectories were not incorporated in the model. After that point, at low risk level there was more reduction in the model with trajectories. In conclusion, our study predicts that sexual trajectories increase the estimated impact of PrEP on reducing HIV prevalence when compared to a population where risk levels do not change.en_US
dc.language.isoenen_US
dc.subjectHIV transmissionen_US
dc.subjectMen who have sex with menen_US
dc.subjectPre-exposure prophylaxisen_US
dc.subjectSexual behavior changeen_US
dc.subjectSexual behavior trajectoriesen_US
dc.titleImpact of sexual trajectories of men who have sex with men on the reduction in HIV transmission by pre-exposure prophylaxis.en_US
dc.typeArticleen_US
dc.identifier.journalEpidemics 2019; advance online publication (ahead of print)en_US
dc.source.journaltitleEpidemics


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