Potential Impact and Cost-Effectiveness of Condomless-Sex–Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance
Year: 2019
Type: article
Abstract: INTRODUCTION: Oral preexposure prophylaxis (PrEP) in the form of tenofovir-disoproxil-fumarate/emtricitabine is being implemented in selected sites in South Africa. Addressing outstanding questions on PrEP cost-effectiveness can inform further implementation. METHODS: We calibrated an individual-based model to KwaZulu-Natal to predict the impact and cost-effectiveness of PrEP, with use concentrated in periods of condomless sex, accounting for effects on drug resistance. We consider (1) PrEP availability for adolescent girls and young women aged 15-24 years and female sex workers, and (2) availability for everyone aged 15-64 years. Our primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programs. RESULTS: In the context of PrEP use in adults aged 15-64 years, there was a predicted 33% reduction in incidence and 36% reduction in women aged 15-24 years. PrEP was cost-effective, including in a range of sensitivity analyses, although with substantially reduced (cost) effectiveness under a policy of ART initiation with efavirenz- rather than dolutegravir-based regimens due to PrEP undermining ART effectiveness by increasing HIV drug resistance. CONCLUSIONS: PrEP use concentrated during time periods of condomless sex has the potential to substantively impact HIV incidence and be cost-effective.
Authors: Andrew N Phillips, Valentina Cambiano, Leigh Johnson, Fumiyo Nakagawa, Rick Homan, Gesine Meyer-Rath, Thomas Rehle, Frank Tanser, Sizulu Moyo, Maryam Shahmanesh, Delivette Castor, Elizabeth Russell, Lise Jamieson, Loveleen Bansi-Matharu, Amir Shroufi, Ruanne V Barnabas, Urvi M Parikh, John W Mellors, Paul Revill
Institutions: University College London, University of Cape Town, Family Health International 360, Boston University, University of the Witwatersrand, Witshealth Consortium (Pty) Ltd. (South Africa), Centre for the AIDS Programme of Research in South Africa, Africa Health Research Institute, University of Lincoln, University of KwaZulu-Natal, Human Sciences Research Council, United States Agency for International Development, Médecins Sans Frontières, University of Washington, University of Pittsburgh, University of York
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
Awards: G1052244587, G144515075, Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women, G3820903925, EVIDENCE IS A PROGRAM OF APPLIED RESEARCH AND EVALUATION, INCLUDING COST AND COST EFFECTIVENESS ANALYSIS, COST MODELING, AND EPIDEMIOLOGICAL ANALYSIS, AIMED AT ASSISTING THE GOVERNMENT OF SOUTH AFRICA TO ACHIEVE THE GOALS OF ITS NATIONAL STRATEGIC PLAN ON HIV, TB AND STIS 2017-2022, NATIONAL AND INTERNATIONAL 90-90-90 TARGETS, AND PEPFAR OBJECTIVES., G492505439, APP FOR AAD 936-3090, G872593607, University of Washington/Fred Hutch Center for AIDS Research
OpenAlex ID: W2994793828