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Introduction: Long-acting injectable cabotegravir (CAB-LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) in the HPTN 083/084 trials. We compared the potential impact of expanding PrEP coverage by offering CAB-LA to men who have sex with men (MSM) in Atlanta (US), Montreal (Canada) and the Netherlands, settings with different HIV epidemics. Methods: Three risk-stratified HIV transmission models were independently parameterized and calibrated to local data. In Atlanta, Montreal and the Netherlands, the models, respectively, estimated mean TDF/FTC coverage starting at 29%, 7% and 4% in 2022, and projected HIV incidence per 100 person-years (PY), respectively, decreasing from 2.06 to 1.62, 0.08 to 0.03 and 0.07 to 0.001 by 2042. Expansion of PrEP coverage was simulated by recruiting new CAB-LA users and by switching different proportions of TDF/FTC users to CAB-LA. Population effectiveness and efficiency of PrEP expansions were evaluated over 20 years in comparison to baseline scenarios with TDF/FTC only. Results: Increasing PrEP coverage by 11 percentage points (pp) from 29% to 40% by 2032 was expected to avert a median 36% of new HIV acquisitions in Atlanta. Substantially larger increases (by 33 or 26 pp) in PrEP coverage (to 40% or 30%) were needed to achieve comparable reductions in Montreal and the Netherlands, respectively. A median 17 additional PYs on PrEP were needed to prevent one acquisition in Atlanta with 40% PrEP coverage, compared to 1000+ in Montreal and 4000+ in the Netherlands. Reaching 50% PrEP coverage by 2032 by recruiting CAB-LA users among PrEP-eligible MSM could avert >45% of new HIV acquisitions in all settings. Achieving targeted coverage 5 years earlier increased the impact by 5–10 pp. In the Atlanta model, PrEP expansions achieving 40% and 50% coverage reduced differences in PrEP access between PrEP-indicated White and Black MSM from 23 to 9 pp and 4 pp, r

The Maritime Area Denial Mine with Autonomous Navigation (MADMAN) project provides a means for asserting maritime dominance through integration of intelligence into mines. This project identifies a path toward reinvigorating mine warfare innovation to develop the mine of the future, MADMAN. Modeling and simulation tools reveal that the highest mission success probabilities support an unmanned underwater vehicle (UUV) option. By integrating current, available systems, a resulting system of systems provides a cost-effective means to develop a mine that is capable of autonomously transiting to a location, arming itself, performing missions, and increasing personnel safety. Using a capability engineering approach, this study identifies an overall target probability of success for the system of systems. This overall success probability decomposes the individual systems and highlights their level of impact on overall success. Analyzing these impacts allows tailoring of each system to provide improved mining and cost savings while meeting project requirements. Resulting collaboration between UUV designers and military engineers ensures a modern arsenal for a modern world.

The Maritime Area Denial Mine with Autonomous Navigation (MADMAN) project provides a means for asserting maritime dominance through integration of intelligence into mines. This project identifies a path toward reinvigorating mine warfare innovation to develop the mine of the future, MADMAN. Modeling and simulation tools reveal that the highest mission success probabilities support an unmanned underwater vehicle (UUV) option. By integrating current, available systems, a resulting system of systems provides a cost-effective means to develop a mine that is capable of autonomously transiting to a location, arming itself, performing missions, and increasing personnel safety. Using a capability engineering approach, this study identifies an overall target probability of success for the system of systems. This overall success probability decomposes the individual systems and highlights their level of impact on overall success. Analyzing these impacts allows tailoring of each system to provide improved mining and cost savings while meeting project requirements. Resulting collaboration between UUV designers and military engineers ensures a modern arsenal for a modern world., http://archive.org/details/developingthemin1094559582, Civilian, Department of the Navy, Civilian, National Aeronautics and Space Administration, Civilian, Department of the Navy, Civilian, Department of the Navy, Lieutenant Commander, United States Navy, Approved for public release; distribution is unlimited.