Stefan Baral FRCPC CCFP Key Populations Program Department of Epidemiology Johns Hopkins School of Public Health Outline Global Epidemiology of HIV among Gay men and other MSM Epidemiology of HIV among MSM in Sub Saharan Africa ID: 809669
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Slide1
The Potential Utility of PREP for Gay men and other MSM across Sub-Saharan Africa
Stefan Baral, FRCPC CCFP
Key Populations Program, Department of Epidemiology, Johns Hopkins School of Public Health
Slide2Outline
Global Epidemiology of HIV among Gay men and other MSM
Epidemiology of HIV among MSM in Sub Saharan Africa
Ongoing PrEP Demonstration Projects for MSM in South Africa
PrEP in other Places?
Moving Forward
Slide3Modified From: Beyrer, Baral, van Griensven, Goodreau, Chariyalertsak, Wirtz, Brookmeyer,
The Lancet,
2012
Global HIV Prevalence among MSM, 2007-2012
Slide4Legend
2012
2013
2005
2006
2007
2008
Senegal
21.5%
(463)
21.8%
(501)
Ghana
25.0%
(N/A)
Nigeria
Sudan
9.3%
(713)
7.3%
(406)
Kenya
24.6%
(285)
Tanzania
12.3%
(509)
Malawi
21.4%
(201)
Soweto
Botswana
19.7%
(117)
Cape Town (Township)
Cape Town
Namibia
12.4%
(218)
Egypt
6.2%
(267)
HIV Prevalence among MSM in Africa
Modified From : van
Griensven
, Baral, et al.
The Global Epidemic of HIV Infection among Men who have Sex with Men.
Curr
Opinion on HIV/AIDS, 2009
2009
2010
2011
The Gambia
13.3%
(215)
4.9%
(
1,778
)
Tunisia
4.4%
(
90
)
Morocco
5.7%
(259)
13.2%
(
306
)
Uganda
5.9%
(262)
40.7
%
(
285
)
19.0%
(563)
0.98%
(n/a)
Burkina Faso
19.0%
(n/a)
Cameroon
37.0%
(511)
CAR
17.0%
(n/a)
50.0%
(96)
Cote d’Ivoire
9.8%
(205)
19.8%
(253)
14.3%
(
449
)
Maputo
8.1%
(358)
Beira
9
.1%
(583)
3
.1%
(353)
Nampula
Zambia
33.0
%
(
641
)
Togo
20.3
%
(
N/A
)
Swaziland
8.1%
(358)
28.9%
(249)
13.4%
(1,125)
17.2%
(1,291)
21.1
%
(712)
10.6%
(538)
25.5%
(200)
2014
Maseru
Maputsoe
35.4%
(211)
31.1%
(318)
Slide5HIV Incidence among MSM, 1995-2014
High Income Countries
Low and Middle Income Countries
Slide6Senegal
Nigeria
Kenya
Malawi
HIV Incidence among MSM in Sub-Saharan Africa
Modified From : van
Griensven
, Baral, et al.
The Global Epidemic of HIV Infection among Men who have Sex with Men.
Curr
Opinion on HIV/AIDS, 2009
Uganda
16.0%
South Africa
14.0%
3.6%
7.2-20%
7.1%
5-6%
Slide7HIV Incidence among MSM in Kilifi, Kenya
Source: Sanders,
Mugo
, van der
Elst
, Smith, Graham. High HIV-1 incidence, correlates of HIV-1acquisition, and high viral loads following seroconversion among MSM JAIDS ,2013
Slide8Modified:
Abdool
Karim et al,
AVAC Report
, 2014
Oral/Topical PrEP Efficacy/Effectiveness
Slide9“Forgiveness”
TFV Concentration: Rectal>Cervical>Vaginal
Patterson KB
et al.
Sci Transl Med. 2011.
Days post single-dose
Slide10HIV prevalence and awareness of HIV positivity by age, Cape Town and Port Elizabeth, South Africa
Slide11Source: Brookmeyer et al,
PLoS
ONE 2014
Modeling Utility of PrEP For MSM in South Africa
Slide12PrEP Continuum for MSM in Cape Town and Port Elizabeth, South Africa, 2014-2016
12
Slide13Person Days on and off PrEP among 80 MSM in Cape Town and Port Elizabeth, South Africa, 2014-2016
Slide14Assess feasibility of delivering PrEP in standard PHC facilities
In line with International and SA Guidelines
300 MSM across 2 sites (Woodstock, CPT &
Yeoville
, JNB)
Minimal additional research components (i.e no active recruitment) SA PrEP Demo Project
Slide15SA PrEP Demo: Retention Outcomes
Source: Brown, Rebe,
Bekker
, McIntyre
Slide16SA PrEP Demo:
Adherence Out
comes
81%
85%
87%19%15%
13%
Source: Brown, Rebe,
Bekker
, McIntyre
Slide17Ever Used any PrEP among MSM
N=532
N=762
Slide18Key Themes
The world is more similar than it is different
Wherever HIV is studied around the world, risk is not evenly distributed
Highest incidence appears to be among young gay men and other MSM
Similar Risk factors for HIV Infections among MSM
Sustained HIV incidence supports the need for addition of PrEPDemonstration data from South Africa suggests feasibility in the context of primary health care facilities
Slide19Acknowledgements
Key Populations Program
Carrie Lyons, Sosthenes Ketende, Ben Liestman, Amrita Rao, Sheree Schwartz, Gnilane Turpin Nunez, Karleen Coly, Shauna Stahlman
Emory
Travis Sanchez, Patrick Sullivan, Rachel Kearns, Ryan ZahnHuman Sciences Research CouncilRefilwe Phaswana-Mafuya, Ebrahim Hossein, Batlile MasekoDesmond Tutu HIV FoundationLinda Gail-Bekker, Karen Dominguez, Ben Brown, Andrew Scheibe CPHHRChris Beyrer, Emily Clouse, Andrea Wirtz, Kristin Hunt, Michele Decker, Len Rubinstein