Mukandavire, Z., Mitchell, K.M., Vickerman, P. Epidemics (March 2016), doi:10.1016/j.epidem.2015.10.002.
This modeling study estimated the relative impact of PrEP and condom use by female sex workers (FSWs) to clarify the importance of PrEP for preventing HIV transmission in this group and compare the benefits of introducing PrEP versus prioritizing the scale-up of condom use among FSWs. The authors stratified the population into three classes, denoting the HIV prevalence among FSWs, their clients, and pimps (boyfriends and "others" in the sex industry). Analyses showed that increasing PrEP use among FSWs was unlikely to result in the same population-level impact as increasing condom use. Furthermore, the relative impact of PrEP was lower than that of condoms for HIV infections averted over 10 years; a >3 percent increase in PrEP coverage achieved the same impact as a 1 percent increase in condom use. A potentially important use for PrEP, the authors said, was to protect FSWs against HIV transmission from pimps and other male sexual partners involved in the sex industry, who might be reluctant to use condoms. The authors concluded that PrEP could be an effective HIV prevention tool for FSWs, but is unlikely to achieve the same population-level impact as existing condom use promotion interventions among FSWs. They recommended that PrEP only be implemented once condom promotion interventions have reached their maximum impact.