{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:59:59Z","timestamp":1790805599046,"version":"4.1.0"},"reference-count":71,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100017035","name":"Johns Hopkins University Center for AIDS Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017035","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,12,20]]},"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      (NG) and\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      (CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG\/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG\/CT is unknown.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An agent-based simulation model of NG\/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Baltimore City, Maryland, USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG\/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG\/CT screening\/testing and (3) PrEP evaluation in the general community (untargeted).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG\/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG\/CT screening (such that individuals experience a 50% annual probability of NG\/CT screening and evaluation for PrEP on NG\/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG\/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG\/CT screening\/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Targeting MSM infected with NG\/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG\/CT diagnosis may be a highly effective entry point for PrEP initialisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023453","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T05:16:03Z","timestamp":1551762963000},"page":"e023453","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Gonorrhoea and chlamydia diagnosis as an entry point for HIV pre-exposure prophylaxis: a modelling study"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3744-9501","authenticated-orcid":false,"given":"Parastu","family":"Kasaie","sequence":"first","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M","family":"Schumacher","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacky M","family":"Jennings","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A","family":"Berry","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A","family":"Tuddenham","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maunank S","family":"Shah","sequence":"additional","affiliation":[{"name":"School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli S","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Rollins School of Public Health, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen W","family":"Hoover","sequence":"additional","affiliation":[{"name":"Division of HIV\/AIDS Prevention, National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L","family":"Gift","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrell","family":"Chesson","sequence":"additional","affiliation":[{"name":"Division of STD Prevention, National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"German","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Dowdy","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,3,4]]},"reference":[{"key":"2025121408445046000_9.3.e023453.1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000423"},{"key":"2025121408445046000_9.3.e023453.2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit437"},{"key":"2025121408445046000_9.3.e023453.3","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32833a8844"},{"key":"2025121408445046000_9.3.e023453.4","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200005010-00009"},{"key":"2025121408445046000_9.3.e023453.5","doi-asserted-by":"publisher","DOI":"10.1136\/sti.75.1.3"},{"key":"2025121408445046000_9.3.e023453.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)91380-7"},{"key":"2025121408445046000_9.3.e023453.7","unstructured":"Centers for Disease Control Prevention. 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