Modeling the HIV epidemic in MSM in Cyprus: Reaching only the 95-95-95 cascade of care targets fails to reduce HIV incidence by 90% in 2030

Abstract

AbstractObjectivesNational responses should be improved and accelerated to meet the target of ending the Acquired ImmunoDeficiency Syndrome (AIDS) epidemic by 2030. In the Republic of Cyprus, Men who have Sex with Men (MSM) are disproportionately affected by Human Immunodeficiency Virus (HIV), accounting approximately for half of all annual HIV diagnoses. This study aims to assess the evolution of HIV incidence in MSM in Cyprus until 2030 under different scenarios.MethodsA model of HIV transmission and progression was calibrated to Cypriot epidemiological data. Four scenarios were examined: status quo, two scenarios focusing on introducing Pre-Exposure Prophylaxis (PrEP), and a 90% HIV incidence reduction scenario.ResultsReaching only the 95-95-95 HIV cascade of care (CoC) targets among MSM fails to achieve the 90% reduction in HIV incidence: the estimated reduction in 2030 compared to 2015 would be 48.6%. Initiating a PrEP intervention only for high risk MSM would cause a modest further reduction in HIV incidence. To meet the 90% HIV reduction target, PrEP should be expanded to both high and medium risk MSM and, after 2025, behavioral interventions should be implemented so as high risk MSM gradually move to the medium risk category.ConclusionsCyprus will not reach the HIV incidence reduction target by 2030 unless PrEP is gradually promoted and delivered to all high and medium risk MSM along with awareness and behavioral interventions.