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. 2022 Nov 1;33(6):808-816.
doi: 10.1097/EDE.0000000000001525. Epub 2022 Jul 27.

Sexual Mixing by HIV Status and Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men: Addressing Information Bias

Kevin M Maloney  1   2 , David Benkeser  3 , Patrick S Sullivan  1 , Colleen Kelley  4 , Travis Sanchez  1 , Samuel M Jenness  1
Affiliations

Sexual Mixing by HIV Status and Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men: Addressing Information Bias

Kevin M Maloney et al. Epidemiology. .

Abstract

Background: Population-level estimates of sexual network mixing for parameterizing prediction models of pre-exposure prophylaxis (PrEP) effectiveness are needed to inform prevention of HIV transmission among men who have sex with men (MSM). Estimates obtained by egocentric sampling are vulnerable to information bias due to incomplete respondent knowledge.

Methods: We estimated patterns of serosorting and PrEP sorting among MSM in the United States using data from a 2017-2019 egocentric sexual network study. Respondents served as proxies to report the HIV status and PrEP use of recent sexual partners. We contrasted results from a complete-case analysis (unknown HIV and PrEP excluded) versus a bias analysis with respondent-reported data stochastically reclassified to simulate unobserved self-reported data from sexual partners.

Results: We found strong evidence of preferential partnering across analytical approaches. The bias analysis showed concordance between sexual partners of HIV diagnosis and PrEP use statuses for MSM with diagnosed HIV (39%; 95% simulation interval: 31, 46), MSM who used PrEP (32%; 21, 37), and MSM who did not use PrEP (83%; 79, 87). The fraction of partners with diagnosed HIV was higher among MSM who used PrEP (11%; 9, 14) compared with MSM who did not use PrEP (4%; 3, 5). Comparatively, across all strata of respondents, the complete-case analysis overestimated the fractions of partners with diagnosed HIV or PrEP use.

Conclusions: We found evidence consistent with HIV and PrEP sorting among MSM, which may decrease the population-level effectiveness of PrEP. Bias analyses can improve mixing estimates for parameterization of transmission models.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:. Serosorting among men who have sex with men in an egocentric sexual network study in the United States (2017–2019)
Panel A: Mixing patterns estimated using the ego-reported data to show the full distribution of ego knowledge; Panel B: Data restricted to exclude unknown HIV status; Panel C: Ego-reported data stochastically reclassified to approximate unobserved self-reported alter data. Percentages shown are median results across 300 simulated datasets.
Figure 2:
Figure 2:. Pre-exposure prophylaxis (PrEP) sorting among men who have sex with men in an egocentric sexual network study in the United States (2017–2019)
Panel A: Mixing patterns estimated using the ego-reported data to show the full distribution of ego knowledge; Panel B: Data restricted to exclude unknown HIV status or PrEP use; Panel C: Ego-reported data stochastically reclassified to approximate unobserved self-reported alter data. Percentages shown are median results across 300 simulated datasets, so bar totals may not sum to 100%.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016: HIV Surveillance Supplemental Report. 2019.
    1. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV Epidemic. JAMA 2019; 321: 844. - PubMed
    1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363: 2587–99. - PMC - PubMed
    1. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387: 53–60. - PMC - PubMed
    1. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med 2012; 4: 151ra125. - PMC - PubMed

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