PrEP Most Effective for Reducing HIV Incidence in Men Who Have Sex With Men

Pre-exposure prophylaxis (PrEP) is the most effective intervention for reducing human immunodeficiency virus (HIV) acquisition among gay and bisexual men who have sex with men (GBMSM) in high-income countries, according to results from a systematic review of recent randomized controlled trials published in PLOS One.

“It is important that the results of this systematic review are interpreted in the context of the restrictions placed upon it by only including randomized controlled trials, and the calendar years of included studies (2013–2021),” wrote a research team from London, England. “This review retrieved far fewer intervention types than previous reviews, possibly because the selection criteria restricted the study type to randomized controlled trials; however randomized controlled trials, when feasible, do provide the best evidence to assess the efficacy of interventions.”

The review included 39 original papers reporting on 37 trials that investigated the effectiveness of various HIV prevention interventions for GBMSM in high-income countries. A total 5 different intervention types were studied: one-to-one counseling (15 papers), online interventions (9 papers), group interventions (7 papers), PrEP (6 papers), and contingency management for substance use (2 papers).

According to the review, the studies provided evidence that one-to-one counseling, group interventions involving between 4 and 10 participants, and individual online interventions could be effective for reducing HIV transmission risk behaviors such as condomless anal intercourse. The only intervention with consistent effectiveness in reducing HIV incidence, however, was PrEP. A pair of high-quality randomized controlled trials reported a reduction of 86% in HIV incidence with PrEP.

The quality of the trials included in the overall review was mixed, researchers reported. More than one-third were high quality, but 11% were of poor quality.

“Targeted and culturally tailored behavioral interventions for subpopulations of GBMSM vulnerable to HIV infection and other sexually transmitted infections should also be considered,” researchers advised, “particularly for GBMSM who cannot access or decline to use PrEP.”

Reference:
Sewell J, Fakoya I, Lampe FC, et al. Effectiveness of interventions aimed at reducing HIV acquisition and transmission among gay and bisexual men who have sex with men (GBMSM) in high income settings: a systematic review. PLoS One. Published online October 19, 2022. doi:10.1371/journal.pone.0276209