A modelling study and cost-effectiveness analysis from Hong Kong finds that in settings with relatively low HIV incidence, providing pre-exposure prophylaxis (PrEP) for men who have sex with men, regardless of their HIV risk, could be more effective at controlling HIV than a targeted approach.

The study, published in Scientific Reports, found that giving PrEP to 30% of men who have sex with men in Hong Kong, regardless of how at risk they are of acquiring HIV, would avert more new infections than prioritising only those with the highest risk of infection. This was combined with a ‘test-and-treat’ strategy, where everybody testing positive for HIV is immediately initiated on antiretroviral treatment.

To date, numerous PrEP modelling studies relating to men who have sex with men have been conducted around the world. However, only a few have been reported from Asia, and these have been carried out in countries such as India and South Korea where heterosexual transmission drives HIV.

In Hong Kong, HIV predominantly affects men who have sex with men and despite relatively low incidence, new infections are increasing (from 170 in 2010 to 464 in 2015). As of 2015, the total number of HIV-positive men who have sex with men stood at 3,151, equating to 5% prevalence. As treatment coverage and viral load suppression rates are already relatively high among this population due to successful test-and-treat strategies, PrEP could offer an effective new way to reverse the rising infection rate.

The World Health Organization (WHO) currently recommends prioritising PrEP for populations at substantial risk of HIV. In settings such as Hong Kong, where the annual number of new HIV infections is relatively low and only a small proportion of men who have sex with men engage in high-risk behaviours, the task of identifying which men who have sex with men are high-risk is challenging. Read more via Avert