Browsing by Author "Plankey, Michael"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
- Eligibility for Pre-exposure Prophylaxis According to Different Guidelines in a Cohort of HIV-Negative Men Who Have Sex with Men in Lisbon, PortugalPublication . Meireles, Paula; Plankey, Michael; Rocha, Miguel; Rojas, Jesus; Brito, João; Barros, HenriqueObjectives Defining eligibility for preexposure prophylaxis (PrEP) is key to measuring the degree of PrEP implementation. While the clinical exclusion criteria are identical across different guidelines, definitions of substantial HIV risk are not. In this study, we aimed to estimate the proportion of men who have sex with men (MSM) being tested at a community-based voluntary human immunodeficiency virus (HIV) counseling and testing center in Lisbon that would be eligible for PrEP according to guidelines from the World Health Organization (WHO), the US Public Health Service and Centers for Disease Control and Prevention (US-CDC), the European AIDS Clinical Society (EACS), and the Portuguese National Health Service (PNHS). Methods We used baseline data from 3392 HIV-negative MSM with valid information on eligibility for PrEP enrolled in the Portuguese Lisbon Cohort of MSM—an observational study designed as an open prospective, noninterval cohort—between March 2014 and March 2018. Results At baseline, the proportion of MSM eligible for PrEP was 67.7% according to the US-CDC, 60.6% according to the PNHS guidelines, 58.9% according to the WHO, and 46.5% according to the EACS guidelines. The most frequently met criteria were those related to condomless anal intercourse. Conclusions In conclusion, in the same population, the proportion of men eligible for PrEP differed by guideline, ranging from 46.5% to 67.7%, though if they all seem to include the same well-known predictors of HIV seroconversion. Policy implications These results show that both the allocation of resources and the approaches to individual risk prediction are highly dependent on the chosen guideline. Moving the focus from assessing risk to assessing whether PrEP is a suitable option for a given individual in a given moment of his life might help to overcome guidelines limitations and create more equitable access.
- Transitions Between Preexposure Prophylaxis Eligibility States and HIV Infection in The Lisbon Cohort of HIV-Negative Men Who Have Sex with Men: a Multistate Model AnalysisPublication . Meireles, Paula; Rocha, Miguel; Moreira, Carla; Plankey, Michael; Barros, HenriqueWe aimed to describe transitions between preexposure prophylaxis (PrEP) eligibility and human immunodeficiency virus (HIV) infection among HIV-negative men who have sex with men (MSM). We used data from 1,885 MSM, who had not used PrEP, enrolled in the Lisbon Cohort of MSM, with at least 2 consecutive measurements of PrEP eligibility from 2014-2020. A time-homogeneous Markov multistate model was applied to describe the transitions between states of PrEP eligibility-eligible and ineligible-and from these to HIV infection (HIV). The intensities of the transitions were closer for ineligible-to-eligible and eligible-to-ineligible transitions (intensity ratio, 1.107, 95% confidence interval (CI): 1.080, 1.176), while the intensity of the eligible-to-HIV transition was higher than that for ineligible-to-HIV transition (intensity ratio, 9.558, 95% CI: 0.738, 65.048). The probabilities of transitions increased with time; for 90 days, the probabilities were similar for the ineligible-to-eligible and eligible-to-ineligible transitions (0.285 (95% CI: 0.252, 0.319) vs. 0.258 (95% CI: 0.228, 0.287)), while the eligible-to-HIV transition was more likely than ineligible-to-HIV (0.004 (95% CI: 0.003, 0.007) vs. 0.001 (95% CI: 0.001, 0.008)) but tended to become closer with time. Being classified as ineligible was a short-term indicator of a lower probability of acquiring HIV. Once an individual moved to eligible, he was at a higher risk of seroconversion, demanding a timely delivery ofPrEP.