Demographic characteristics, self-identification, and sexual orientation among MSM who answered an online survey in Peru (N = 1301).

<p>*Numbers may not add to the total because of missing data.</p>&<p>Includes transvestite, transgender and transsexual.</p

Comparison of the main reasons for not getting tested for HIV among MSM who had not tested for HIV within the last year, stratified by level of risk (n = 801).

<p>*Numbers may not add to the total because of missing data.</p>&<p>The low-risk group included participants whose last sexual partner was stable (regardless of whether they used a condom or not) and participants whose last sexual partner was not stable but who used a condom in their last sexual intercourse. The high-risk group included participants who had a non-stable last sexual partner with whom they did not use a condom during their last sexual intercourse.</p

Sexual and non-sexual risk behaviors for HIV/STI among MSM who answered an online survey in Peru (N = 1301).

<p>*Numbers may not add to the total because of missing data.</p

The potential impact and cost of focusing HIV prevention on young women and men: A modeling analysis in western Kenya - Fig 5

<p><b>Comparison of cumulative impact and costs over 35 years of youth-focused to adult-focused scenarios with (A) default annual care costs per person in late stages of HIV and (B) when these care costs are much higher.</b> The comparison involved 65 scenarios but in the plots, only potentially cost-effective scenarios (red colored points) and selected dominated scenarios (blue colored points) are shown. Cost frontiers (lines through red points) are shown in terms of DALYs averted and infections averted (top and bottom figures, respectively) at 5 and 20 years (A and B panels, respectively). M = million.</p

Model inputs.

<p>Model inputs.</p

The potential impact and cost of focusing HIV prevention on young women and men: A modeling analysis in western Kenya

<div><p>Objective</p><p>We compared the impact and costs of HIV prevention strategies focusing on youth (15–24 year-old persons) versus on adults (15+ year-old persons), in a high-HIV burden context of a large generalized epidemic.</p><p>Design</p><p>Compartmental age-structured mathematical model of HIV transmission in Nyanza, Kenya.</p><p>Interventions</p><p>The interventions focused on youth were high coverage HIV testing (80% of youth), treatment at diagnosis (TasP, i.e., immediate start of antiretroviral therapy [ART]) and 10% increased condom usage for HIV-positive diagnosed youth, male circumcision for HIV-negative young men, pre-exposure prophylaxis (PrEP) for high-risk HIV-negative females (ages 20–24 years), and cash transfer for in-school HIV-negative girls (ages 15–19 years). Permutations of these were compared to adult-focused HIV testing coverage with condoms and TasP.</p><p>Results</p><p>The youth-focused strategy with ART treatment at diagnosis and condom use without adding interventions for HIV-negative youth performed better than the adult-focused strategy with adult testing reaching 50–60% coverage and TasP/condoms. Over the long term, the youth-focused strategy approached the performance of 70% adult testing and TasP/condoms. When high coverage male circumcision also is added to the youth-focused strategy, the combined intervention outperformed the adult-focused strategy with 70% testing, for at least 35 years by averting 94,000 more infections, averting 5.0 million more disability-adjusted life years (DALYs), and saving US$46.0 million over this period. The addition of prevention interventions beyond circumcision to the youth-focused strategy would be more beneficial if HIV care costs are high, or when program delivery costs are relatively high for programs encompassing HIV testing coverage exceeding 70%, TasP and condoms to HIV-infected adults compared to combination prevention programs among youth.</p><p>Conclusion</p><p>For at least the next three decades, focusing in high burden settings on high coverage HIV testing, ART treatment upon diagnosis, condoms and male circumcision among youth may outperform adult-focused ART treatment upon diagnosis programs, unless the adult testing coverage in these programs reaches very high levels (>70% of all adults reached) at similar program costs. Our results indicate the potential importance of age-targeting for HIV prevention in the current era of ‘test and start, ending AIDS’ goals to ameliorate the HIV epidemic globally.</p></div

Assumptions of first set of comparison scenarios.

<p>Assumptions of first set of comparison scenarios.</p

Assumptions of second set of comparison scenarios.

<p>Assumptions of second set of comparison scenarios.</p

A schematic outlining our analysis.

<p>Comparison scenarios depicted in the three bottom boxes connected by the decision making solid lines are incremental to the scenario shown in the top box of: 1) 40% HIV testing among adults ages≥15 and prompt initiation of ART at CD4 ≤350 cells/mm³ 2) undiagnosed infected persons presenting late to care/initiating treatment at CD4 ≤250 cells/mm³, and 3) male circumcision uptake of 37%. The comparison scenarios focusing on adults consisted of increased HIV testing among adults (from 40% up to 80% coverage) and provision of TasP and condoms. The rest of the comparison scenarios depicted in shaded blocks focus on youth where in one set HIV testing coverage is increased specifically among youth to 80% and diagnosed youth are provided TasP while condoms were provided to all newly diagnosed persons and all other baseline services are kept (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0175447#pone.0175447.t002" target="_blank">Table 2</a>). In the other set of scenarios beside the previous scenario of 80% testing coverage among youth with TasP/condoms, gender-age-tailored interventions for susceptible youth are combined at various coverage and/or efficacy values (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0175447#pone.0175447.t003" target="_blank">Table 3</a>).</p

Cumulative probability of visiting an HIV clinic.

<p>Results are overall among a) all HIV seropositive persons (n = 152) and b) those not already on ART at baseline (n = 120). After month one, for those on ART, follow-up was discontinued. The cumulative probability of visiting an HIV clinic by 3 months was 88.5% overall and 85.3% among those not already on ART at baseline (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051620#pone-0051620-g001" target="_blank">Figure 1a and 1b</a>, respectively).</p