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Using Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles County.

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Implementing pre-exposure prophylaxis (PrEP) strategies proportionally to HIV diagnosis rates significantly reduces new HIV infections and racial disparities among men who have sex with men in Los Angeles County.

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Area of Science:

  • Epidemiology
  • Public Health Policy
  • Health Equity

Background:

  • Pre-exposure prophylaxis (PrEP) is crucial for HIV prevention, but its uptake is unequal across racial and ethnic groups.
  • This study addresses disparities in PrEP access and impact among men who have sex with men (MSM) in Los Angeles County.

Purpose of the Study:

  • To estimate the health and racial equity impacts of three alternative PrEP implementation strategies.
  • To compare these strategies against the current Status-quo approach over a 15-year period (2021-2035).

Main Methods:

  • A microsimulation model of HIV transmission was developed with stakeholder input.
  • Three strategies were evaluated: equal PrEP allocation, allocation proportional to HIV prevalence, and allocation proportional to HIV diagnosis rates.
  • The Gini index was used to measure health impact equity across racial and ethnic groups.

Main Results:

  • Strategy 3 (proportional to diagnosis rates) averted the most infections (10.2% overall) and reduced HIV racial inequalities (Gini index reduction of 0.08).
  • Black MSM experienced the highest burden of HIV and greatest benefit from Strategy 3 (32.4% infections averted).
  • While strategies reduced Black-MSM and Latino-MSM disparities, none eliminated Latino-MSM and White-MSM disparities by 2035.

Conclusions:

  • Microsimulation models, informed by stakeholder engagement, are valuable for guiding HIV prevention policy.
  • Allocating PrEP proportionally to HIV diagnosis rates is the most effective strategy for reducing infections and promoting health equity among MSM in Los Angeles County.