prophylaxis (PrEP)—an effective and safe intervention to prevent HIV
transmission—was recently approved by the Food and Drug Administration
for use by adolescents. Informed by studies of sexual behavior and PrEP
adherence, retention, and promotion, we model the potential impact of
PrEP use among at-risk adolescent sexual minority males.
simulate an HIV epidemic among men who have sex with men (MSM) aged
13–39. We assume adult MSM ages 19–39 have had PrEP available for 3
years with 20% coverage among eligible MSM based on the Centers for
Disease Control and Prevention guidelines. PrEP interventions for ages
16–18 are then simulated using adherence and retention profiles drawn
from the ATN113 and Enhancing Preexposure Prophylaxis in Community
studies across a range of uptake parameters (10%–100%). Partnerships
across age groups were modeled using parameterizations from the RADAR
study. We compare the percent of incident infections averted (impact),
person-years on PrEP per infection averted (efficiency), and changes in
prevalence over 10 years.
compared to no PrEP use, baseline PrEP adherence and retention among
adolescent sexual minority males drawn from the ATN113 and Enhancing
Preexposure Prophylaxis in Community studies averted from 2.8% to 41.0%
of HIV infections depending on the fraction of eligible adolescent
sexual minority males that initiated PrEP at their annual health-care
visit. Improved adherence and retention achieved with an array of
focused interventions from real-world settings increased the percent of
infections averted by as much as 26%–70%.
demonstrated improvements in the PrEP continuum of care in response to
existing interventions can substantially reduce incident HIV infections
among adolescent sexual minority males.