The Potential Impact of a Gel-Based Point-of-Sex Intervention in Reducing Gonorrhea Incidence Among Gay and Bisexual Men: A Modeling Study. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Traeger, Michael W.; Tidhar, Tom; Holt, Martin; Williams, Chris; Wright, Edwina J.; Stoové, Mark A.; Scott, Nick; Hellard, Margaret E.
• Is Part Of: Sexually transmitted diseases. Volume 47:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001239
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: Increases in sexually transmitted infections among gay and bisexual men (GBM) over the past decade have coincided with declines in condom use and rapid uptake of HIV preexposure prophylaxis (PrEP). We explored the impact of an antimicrobial gel-based point-of-sex intervention (gel-PSI) with a lower efficacy for reducing gonorrhea transmission risk than condoms on population-level gonorrhea incidence among GBM in Victoria, Australia. Methods: A deterministic compartmental model of HIV and gonorrhea transmission was used to project annual gonorrhea incidence from 2020 to 2025. Individuals were classified as HIV-negative (PrEP or non-PrEP users) or HIV-positive, and further stratified by gonorrhoea risk (high/low). All possible scenarios where between 0% and 100% of GBM using condoms transitioned to gel-PSI (considered a downgrade in protection) and 0% and 100% of GBM not using condoms transitioned to gel-PSI (considered an upgrade in protection), with gel-PSI efficacy ranging from 20% to 50%, were run. Results: The baseline scenario of no gel-PSI uptake (status quo) projected 94, 367 gonorrhea infections between 2020 and 2025, with an exponentially increasing trend in annual infections. For a gel-PSI efficacy of 30%, a net reduction in cumulative gonorrhea incidence was projected, relative to the status quo, for any ratio of proportion of condom users "downgrading" to proportion of noncondom users "upgrading" to gel-PSI use of less than 2.6. Under the supposition of equal proportions of condom users and noncondom users switching to gel-PSI, a relative reduction was projected for any gel-PSI efficacy greater than 16%. Conclusions: Our model suggests that the introduction of a gel-PSI could have benefits for controlling gonorrhea transmission among GBM, even in scenarios where the gel-PSI is considerably less efficacious than condoms and when gel-PSI uptake leads to consequent reductions in consistent condom use. Abstract : This modeling study found that the introduction of a gel-based antimicrobial intervention that is less efficacious than condoms may lead to population-level reductions in gonorrhea among gay and bisexual men.Supplemental digital content is available in the text.