{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:04:48Z","timestamp":1740128688748,"version":"3.37.3"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008196","name":"M\u00e9decins sans Fronti\u00e8res","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In Western Kenya up to one-quarter of the adult population was human immunodeficiency virus (HIV)-infected in 2012. The Ministry of Health, M\u00e9decins Sans Fronti\u00e8res, and partners implemented an HIV program that surpassed the 90-90-90 UNAIDS targets. In this generalized epidemic, we compared the effectiveness of preexposure prophylaxis (PrEP) with improving continuum of care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We developed a dynamic microsimulation model to project HIV incidence and infections averted to 2030. We modeled 3 strategies compared to a 90-90-90 continuum of care base case: (1) scaling up the continuum of care to 95-95-95, (2) PrEP targeting young adults with 10% coverage, and (3) scaling up to 95-95-95 and PrEP combined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the base case, by 2030 HIV incidence was 0.37\/100 person-years. Improving continuum levels to 95-95-95 averted 21.5% of infections, PrEP averted 8.0%, and combining 95-95-95 and PrEP averted 31.8%. Sensitivity analysis showed that PrEP coverage had to exceed 20% to avert as many infections as reaching 95-95-95.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In a generalized HIV epidemic with continuum of care levels at 90-90-90, improving the continuum to 95-95-95 is more effective than providing PrEP. Continued improvement in the continuum of care will have the greatest impact on decreasing new HIV infections.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaa633","type":"journal-article","created":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T19:32:54Z","timestamp":1602531174000},"page":"1032-1039","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness of Interventions to Improve the HIV Continuum of Care and HIV Preexposure Prophylaxis in Kenya: A Model-Based Analysis"],"prefix":"10.1093","volume":"225","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5235-0868","authenticated-orcid":false,"given":"Liem B","family":"Luong Nguyen","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Paris, Infection Antimicrobien Modelisation Evolution, INSERM, Paris, France"},{"name":"Unit\u00e9 des Maladies Emergentes, Institut Pasteur, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth A","family":"Freedberg","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Health Policy and Management, Harvard T. 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Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sitima","family":"Wanjala","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Maman","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Szumilin","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Mendiharat","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yazdan","family":"Yazdanpanah","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris, Infection Antimicrobien Modelisation Evolution, INSERM, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"author":"UNAIDS","key":"2022031508221872100_CIT0001"},{"key":"2022031508221872100_CIT0002","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1093\/cid\/ciu018","article-title":"Antiretroviral therapy for the prevention of HIV transmission: what will it take?","volume":"58","author":"McNairy","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2022031508221872100_CIT0003","doi-asserted-by":"crossref","first-page":"e831","DOI":"10.1016\/S2352-3018(19)30196-1","article-title":"Global, regional, and national incidence, prevalence, and mortality of HIV, 1980\u20132017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017","volume":"6","author":"GBD 2017 HIV Collaborators","year":"2019","journal-title":"Lancet HIV"},{"key":"2022031508221872100_CIT0004","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/COH.0b013e32835b80dd","article-title":"Fifteen million people on antiretroviral treatment by 2015: treatment as prevention","volume":"8","author":"Granich","year":"2013","journal-title":"Curr Opin HIV AIDS"},{"year":"2014","author":"UNAIDS","key":"2022031508221872100_CIT0005"},{"key":"2022031508221872100_CIT0006","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1097\/QAD.0000000000000741","article-title":"Cascade of HIV care and population viral suppression in a high-burden region of Kenya","volume":"29","author":"Maman","year":"2015","journal-title":"AIDS"},{"author":"Conan","key":"2022031508221872100_CIT0007","article-title":"Progress in viral load suppression among HIV-infected people in two high HIV prevalence settings. 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