{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:45:16Z","timestamp":1788245116250,"version":"build-2803163510"},"reference-count":51,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>HIV pre\u2010exposure prophylaxis (PrEP) has been recommended and partly subsidized in Qu\u00e9bec, Canada, since 2013. We evaluated the population\u2010level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montr\u00e9al, Qu\u00e9bec's largest city, over 2013\u20132021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used an agent\u2010based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID\u201019 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual\u2010level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post\u2010exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (\u226511 anal sex partners annually) or aged \u2a7d45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free\u2010of\u2010charge), and improving retention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over 2013\u20132021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3\u20130.6) to 0.2 (90% CrI: 0.1\u20130.2) per 100 person\u2010years. PrEP coverage among HIV\u2010negative MSM remained low until 2015 (&lt;1%). Afterwards, coverage increased to a maximum of 10% of all HIV\u2010negative MSM, or about 16% of the 62% PrEP\u2010eligible HIV\u2010negative MSM in 2020. Over 2015\u20132021, PrEP averted an estimated 20% (90% CrI: 11%\u201330%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%\u201342%) of HIV acquisitions from 2015\u20102021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV\u2010negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%\u201370%) of HIV acquisitions from 2015 to 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PrEP reduced population\u2010level HIV transmission among Montr\u00e9al MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26194","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T17:52:28Z","timestamp":1701885148000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Population\u2010level effectiveness of pre\u2010exposure prophylaxis for HIV prevention among men who have sex with men in Montr\u00e9al (Canada): a modelling study of surveillance and survey data"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5104-3068","authenticated-orcid":false,"given":"Carla M.","family":"Doyle","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics School of Population and Global Health McGill University Montr\u00e9al 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Biostatistics School of Population and Global Health McGill University Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Lambert","sequence":"additional","affiliation":[{"name":"Direction R\u00e9gionale de Sant\u00e9 Publique de Montr\u00e9al Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Tremblay","sequence":"additional","affiliation":[{"name":"Centre de Recherche du Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al (CRCHUM) Montr\u00e9al Qu\u00e9bec Canada"},{"name":"D\u00e9partement de Microbiologie Infectiologie et Immunologie Universit\u00e9 de Montr\u00e9al Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Otis","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Sexologie Universit\u00e9 du Qu\u00e9bec \u00e0 Montr\u00e9al Montr\u00e9al Qu\u00e9bec 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