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Title: Modelling HIV transmission and control among men who have sex with men in the United Kingdom
Author: Punyacharoensin, N.
ISNI:       0000 0004 5365 5959
Awarding Body: London School of Hygiene and Tropical Medicine (University of London)
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2015
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Background and objectives: Men who have sex with men (MSM) remain one of the groups with the highest HIV prevalence in the UK. The goal of this study is to help inform appropriate health policy by investigating the contribution to HIV transmission of various MSM subgroups and estimating the impacts of alternative HIV control measures. The future course of the epidemic is also projected. Methods: Research questions were addressed through the use of rigorous data analysis and a partnership-based HIV transmission model that takes into account key MSM and HIV heterogeneities and intervention effects. The model was fitted and validated against the observed data and reported estimates of various types. Sensitivity analyses were conducted throughout the study to assess the effects of parameter uncertainty. Results Without additional interventions, the estimated 44,000 UK MSM living with HIV in 2013 could increase to around 52,000 men by the end of the decade, with around 2,400 new infections each year. The key group sustaining HIV transmission was the higher-sexual activity MSM aged below 35 years living with undiagnosed asymptomatic HIV. Pre-exposure prophylaxis (PrEP) with 44% efficacy and 100% coverage would prevent approximately 10,000 cases (59% of total incidence) over 2014–2020. Simultaneously offering PrEP, expanding HIV testing, and initiating a test-and-treat programme in 25% of different target populations could save around 7,400 UK MSM from HIV. An extreme increase in unsafe sex and number of sexual partners would greatly reduce the incidence reduction but is unlikely to completely negate the prevention benefit. Conclusion: Increasing HIV testing uptake should remain the core of the national HIV/AIDS strategy, but a combination of HIV prevention interventions are also necessary to enhance the overall performance of HIV control measures. Combining a program to expand HIV testing with other novel interventions, such as test-and-treat and PrEP, has a great potential to save thousands of UK MSM from HIV and become the key HIV prevention initiatives in the UK.
Supervisor: White, R. Sponsor: Public Health England
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral