[Impact of the 90-90-90 goal and pre-exposure prophylaxis on HIV transmission and elimination in men who have sex with men in China: A mathematical modeling study].

Objective: To establish a dynamic compartmental model to predict the impact of HIV testing and treatment and pre-exposure prophylaxis (PrEP) on the annual incidence of HIV infection in men who have sex with men (MSM) in China from 2018 to 2037. Methods: A dynamic compartmental model was developed to describe the HIV epidemic in MSM in China. The model was parameterized using data from the literature available. We used MATLAB 7.0 software for data simulation and graphics rendering. We analyzed HIV transmission among MSM and estimated the impact of expanded HIV testing and treatment and PrEP on HIV elimination in MSM. Results: Under the current policy, the number of new HIV infections would reach 770 000, the infection rate would reach 11.1% and the incidence rate would reach 0.72/100 person years in MSM in the next 20 years. Under the 90%-90%-90% goal, 440 000 new infections (57.7%) would be reduced, the HIV infection rate would decline to 5.7% and the incidence rate would decline to 0.24/100 person years in the next 20 years, but it is still unlikely to achieve the goal of HIV elimination. With 100% PrEP compliance, the required PrEP coverage rates for achieving HIV elimination in the next 10, 15 and 20 years would be 65%, 32% and 19%, respectively. Conclusion: It is necessary to strengthen the comprehensive intervention in MSM, continue to expand HIV testing and treatment, and improve PrEP adherence and coverage to further control and eliminate the epidemic of HIV/AIDS in MSM.目的： 通过构建传染病动力学模型，预测2018－2037年扩大HIV检测和治疗与暴露前预防用药（pre-exposure prophylaxis，PrEP）对我国MSM人群艾滋病流行趋势和消除的影响。 方法： 构建我国MSM人群中的传播动力学模型，通过文献查阅收集模型运行所需的输入参数及校准参数。运用MATLAB 7.0软件将模型参数及微分方程进行编程和计算，分析HIV在MSM人群中的传播规律，探讨扩大HIV检测和治疗与PrEP的组合措施对该人群消除艾滋病的影响。 结果： 在现有政策下，我国2018－2037年MSM人群HIV新发感染人数将达77万人。到2037年HIV感染率将达到11.1%，发病率达到0.72/100人年。采用扩大HIV检测与治疗措施后，2018－2037年将减少44万（即减少57.7%）的HIV新发感染，到2037年该人群的HIV感染率下降至5.7%，HIV发病率下降到0.24/100人年，但无法达到消除艾滋病目标。采用"三个90%"目标与PrEP组合干预措施，当PrEP依从性为100%时，未来10、15和20年内达到消除艾滋病目标，高风险MSM人群的PrEP覆盖率需分别为65%、32%、19%。 结论： 我国应对MSM人群继续扩大艾滋病的检测和治疗，提高PrEP依从性和覆盖率，以控制及消除MSM人群艾滋病的流行。.