1. Estimating the potential to prevent locally acquired HIV infections in a UNAIDS Fast-Track City, Amsterdam.
- Author
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Blenkinsop A, Monod M, van Sighem A, Pantazis N, Bezemer D, Op de Coul E, van de Laar T, Fraser C, Prins M, Reiss P, de Bree GJ, and Ratmann O
- Subjects
- Bayes Theorem, Cities epidemiology, Homosexuality, Male, Humans, Male, Phylogeny, Acquired Immunodeficiency Syndrome epidemiology, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections prevention & control
- Abstract
Background: More than 300 cities including the city of Amsterdam in the Netherlands have joined the UNAIDS Fast-Track Cities initiative, committing to accelerate their HIV response and end the AIDS epidemic in cities by 2030. To support this commitment, we aimed to estimate the number and proportion of Amsterdam HIV infections that originated within the city, from Amsterdam residents. We also aimed to estimate the proportion of recent HIV infections during the 5-year period 2014-2018 in Amsterdam that remained undiagnosed., Methods: We located diagnosed HIV infections in Amsterdam using postcode data (PC4) at time of registration in the ATHENA observational HIV cohort, and used HIV sequence data to reconstruct phylogeographically distinct, partially observed Amsterdam transmission chains. Individual-level infection times were estimated from biomarker data, and used to date the phylogenetically observed transmission chains as well as to estimate undiagnosed proportions among recent infections. A Bayesian Negative Binomial branching process model was used to estimate the number, size, and growth of the unobserved Amsterdam transmission chains from the partially observed phylogenetic data., Results: Between 1 January 2014 and 1 May 2019, there were 846 HIV diagnoses in Amsterdam residents, of whom 516 (61%) were estimated to have been infected in 2014-2018. The rate of new Amsterdam diagnoses since 2014 (104 per 100,000) remained higher than the national rates excluding Amsterdam (24 per 100,000), and in this sense Amsterdam remained a HIV hotspot in the Netherlands. An estimated 14% [12-16%] of infections in Amsterdan MSM in 2014-2018 remained undiagnosed by 1 May 2019, and 41% [35-48%] in Amsterdam heterosexuals, with variation by region of birth. An estimated 67% [60-74%] of Amsterdam MSM infections in 2014-2018 had an Amsterdam resident as source, and 56% [41-70%] in Amsterdam heterosexuals, with heterogeneity by region of birth. Of the locally acquired infections, an estimated 43% [37-49%] were in foreign-born MSM, 41% [35-47%] in Dutch-born MSM, 10% [6-18%] in foreign-born heterosexuals, and 5% [2-9%] in Dutch-born heterosexuals. We estimate the majority of Amsterdam MSM infections in 2014-2018 originated in transmission chains that pre-existed by 2014., Conclusions: This combined phylogenetic, epidemiologic, and modelling analysis in the UNAIDS Fast-Track City Amsterdam indicates that there remains considerable potential to prevent HIV infections among Amsterdam residents through city-level interventions. The burden of locally acquired infection remains concentrated in MSM, and both Dutch-born and foreign-born MSM would likely benefit most from intensified city-level interventions., Funding: This study received funding as part of the H-TEAM initiative from Aidsfonds (project number P29701). The H-TEAM initiative is being supported by Aidsfonds (grant number: 2013169, P29701, P60803), Stichting Amsterdam Dinner Foundation, Bristol-Myers Squibb International Corp. (study number: AI424-541), Gilead Sciences Europe Ltd (grant number: PA-HIV-PREP-16-0024), Gilead Sciences (protocol numbers: CO-NL-276-4222, CO-US-276-1712, CO-NL-985-6195), and M.A.C AIDS Fund., Competing Interests: AB, MM, DB, EO, Tv, CF, OR No competing interests declared, Av Funding for managing the ATHENA cohort is supported by a grant from the Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment. Received grants unrelated to this study from European Centre for Disease Prevention and Control paid to author's institution, NP Received grants unrelated to this study from ECDC and Gilead Sciences Hellas, paid to author's institution. Received honoraria for presentations unrelated to this study from Gilead Sciences Hellas, MP Received unrestricted research grants and speaker/ advisory fees from Gilead Sciences, Abbvie and MSD; all of which were paid to author's institute and were unrelated to this study, PR Has received grants unrelated to this study from Gilead Sciences, ViiV Healthcare and Merck, paid to author's institution. Received Honoraria for lecture from Merck paid to institution. Received Honoraria from Gilead Sciences, ViiV Healthcare and Merck, paid to institution, Gd Received honoraria to her Institution for scientific advisory board participations for Gilead Sciences and speaker fees from Gilead Sciences (2019), Takeda (2018-2022) and ExeVir (2020-current), (© 2022, Blenkinsop et al.)
- Published
- 2022
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