Are Unequal Policies in Pre-Exposure Prophylaxis Uptake Needed to Improve Equality? An Examination among Men Who Have Sex with Men in Los Angeles County

Anthony Nguyen, Emmanuel Fulgence Drabo, Wendy H. Garland, Corrina Moucheraud, Ian W. Holloway, Arleen Leibowitz, Sze Chuan Suen

Research output: Contribution to journalArticlepeer-review

Abstract

Racial and ethnic minority men who have sex with men (MSM) are disproportionately affected by HIV/AIDS in Los Angeles County (LAC), an important epicenter in the battle to end HIV. We examine tradeoffs between effectiveness and equality of pre-exposure prophylaxis (PrEP) allocation strategies among different racial and ethnic groups of MSM in LAC and provide a framework for quantitatively evaluating disparities in HIV outcomes. To do this, we developed a microsimulation model of HIV among MSM in LAC using county epidemic surveillance and survey data to capture demographic trends and subgroup-specific partnership patterns, disease progression, patterns of PrEP use, and patterns for viral suppression. We limit analysis to MSM, who bear most of the burden of HIV/AIDS in LAC. We simulated interventions where 3000, 6000, or 9000 PrEP prescriptions are provided annually in addition to current levels, following different allocation scenarios to each racial/ethnic group (Black, Hispanic, or White). We estimated cumulative infections averted and measures of equality, after 15 years (2021-2035), relative to base case (no intervention). By comparing allocation strategies on the health equality impact plane, we find that, of the policies evaluated, targeting PrEP preferentially to Black individuals would result in the largest reductions in incidence and disparities across the equality measures we considered. This result was consistent over a range of PrEP coverage levels, demonstrating that there are "win-win"PrEP allocation strategies that do not require a tradeoff between equality and efficiency.

Original languageEnglish (US)
Pages (from-to)300-312
Number of pages13
JournalAIDS patient care and STDs
Volume36
Issue number8
DOIs
StatePublished - Aug 2022

Keywords

  • AIDS
  • disparities
  • HIV
  • microsimulation
  • MSM
  • pre-exposure prophylaxis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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