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The future role of rectal and vaginal microbicides to prevent HIV infection in heterosexual populations: implications for product development and prevention

Marie-Claude Boily; Dobromir Dimitrov; Salim Abdool Karim; Benoit Masse

Title:
The future role of rectal and vaginal microbicides to prevent HIV infection in heterosexual populations: implications for product development and prevention
Author(s):
Boily, Marie-Claude
Dimitrov, Dobromir
Abdool Karim, Salim
Masse, Benoit
Date:
Type:
Articles
Department:
Epidemiology
Volume:
87
Permanent URL:
Book/Journal Title:
Sexually Transmitted Infections
Abstract:
Objectives To compare the potential impact of rectal (RMB), vaginal (VMB) and bi-compartment (RVMB) (applied vaginally and protective during vaginal and anal intercourse) microbicides to prevent HIV in various heterosexual populations. To understand when a RMB is as useful than a VMB for women practicing anal intercourse (AI). Methods Mathematical model was used to assess the population-level impact (cumulative fraction of new HIV infections prevented (CFP)) of the three different microbicides in various intervention scenarios and prevalence settings. We derived the break-even RMB efficacy required to reduce a female's cumulative risk of HIV infection by the same amount than a VMB. Results Under optimistic coverage (fast roll-out, 100% uptake), a 50% efficacious VMB used in 75% of sex acts in population without AI may prevent ~33% (27, 42%) new total (men and women combined) HIV infections over 25 years. The 25-year CFP reduces to ~25% (20, 32%) and 17% (13, 23%) if uptake decreases to 75% and 50%, respectively. Similar loss of impact (by 25%–50%) is observed if the same VMB is introduced in populations with 5%–10% AI and for RRRAI=4–20. A RMB is as useful as a VMB (ie, break-even) in populations with 5% AI if RRRAI=20 and in populations with 15%–20% AI if RRRAI=4, independently of adherence as long as it is the same with both products. The 10-year CFP with a RVMB is twofold larger than for a VMB or RMB when AI=10% and RRRAI=10. Conclusions Even low AI frequency can compromise the impact of VMB interventions. RMB and RVMB will be important prevention tools for heterosexual populations.
Subject(s):
Virology
Epidemiology
Publisher DOI:
10.1136/sextrans-2011-050184
Item views:
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Metadata:
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