In the fight against HIV, a computer projection model finds that offering pre-exposure prophylaxis through community-based methods shows promise for reaching more people.
A modeling study was carried out to find ways to make pre-exposure prophylaxis (PrEP) more accessible by integrating HIV self-testing. While self-testing allows people to check their HIV status privately, there's concern that it may not be as sensitive as tests done in medical facilities. This could lead to people who already have HIV starting PrEP, potentially leading to drug resistance. The study, published in Lancet HIV, explores how using HIV self-testing might affect the large-scale rollout of PrEP.
Computer Model: EMOD-HIV
The open-source HIV epidemiological modeling software EMOD-HIV was used to simulate the introduction of PrEP in Western Kenya, considering four different testing methods: tests conducted by healthcare providers for detecting nucleic acids or rapid-testing for antibodies, and self-testing with either blood samples or oral fluids.
Factors Considered
The study focused on adults between 18 and 49 years old in heterosexual relationships who tested negative for HIV and were thus candidates for PrEP.
The researchers looked at how quickly and effectively PrEP could be introduced over 20 years and its financial implications over 5 years under these testing modalities.
The Study’s Projections
The findings suggest that reaching 29% PrEP coverage could prevent about 54% of new HIV infections and reduce HIV-related deaths by 17% among the target age group over 2 decades, regardless of the testing method used for PrEP delivery.
The risk of developing drug resistance due to PrEP was low across all scenarios. Specifically, blood self-testing and oral fluid self-testing had a slightly higher, but still low, chance of leading to drug resistance compared to provider-administered tests.
When considering the overall financial impact, using self-testing for PrEP delivery was as cost-effective as antibody rapid diagnostic tests administered by healthcare providers, while nucleic acid testing methods were about 50% more expensive.
Conclusion: PrEP Combined With Self Testing Is on Par With Provider-Administered Testing Methods
The study concluded that scaling up PrEP with the aid of self-testing offers similar health benefits and costs and a minimal risk of developing drug resistance compared to traditional provider-administered testing methods. This suggests policymakers should think about including HIV self-testing as a strategy to increase PrEP usage among those at risk of HIV, potentially making a significant impact on the prevention effort.
Source:
Cox, S. N., Wu, L., Wittenauer, R., Clark, S., Roberts, D. A., Nwogu, I. B., Vitruk, O., Kuo, A. P., Johnson, C., Jamil, M. S., Sands, A., Schaefer, R., Kisia, C., Baggaley, R., Stekler, J. D., Akullian, A., & Sharma, M. (2024). Impact of HIV self-testing for oral pre-exposure prophylaxis scale-up on drug resistance and HIV outcomes in western Kenya: a modelling study. Lancet HIV, 11(3), e167-e175. https://doi.org/10.1016/s2352-3018(23)00268-0
