@article {YingA219, author = {R Ying and C Celum and J Baeten and P Murnane and T Hong and M Krows and H van Rooyen and H Humphries and J P Hughes and R Barnabas}, title = {P3.226 Pre-Exposure Prophylaxis (PrEP) is Estimated to Be a Cost-Effective Addition to Antiretroviral Therapy (ART) For HIV Prevention in a Generalised Epidemic Setting}, volume = {89}, number = {Suppl 1}, pages = {A219--A219}, year = {2013}, doi = {10.1136/sextrans-2013-051184.0683}, publisher = {The Medical Society for the Study of Venereal Disease}, abstract = {Background In KwaZulu-Natal, South Africa, young women face an extraordinarily high risk for HIV acquisition, with annual incidence estimates of 6\%. ART-based strategies for HIV prevention have the potential to significantly decrease HIV incidence, but the impact of PrEP in addition to ART scale-up is undefined. Modeling studies suggest that PrEP targeted to highest-risk groups could maximise benefits and contain costs. Methods We developed a deterministic transmission model of HIV that stratifies the population by age, sexual activity, and includes HIV infection stage. The model was parameterized using data from community-based HIV counselling and testing studies in KwaZulu-Natal and validated using independent HIV prevalence and incidence estimates. We estimated the effectiveness and cost-effectiveness of a {\textquoteleft}test and treat{\textquoteright} scenario, targeted PrEP by age and sexual activity, and general PrEP provision. Each scenario was in addition to anticipated baseline ART scale-up for CD4<= 350 from 35\% in 2013, as observed in KwaZulu-Natal, to 60\% in 2018 (following national guidelines). We assumed PrEP efficacy of 70\%. Results {\textquoteleft}Test and treat{\textquoteright} (ART for 80\% of all HIV-positive persons) reduced HIV incidence by 58\% and averted 25\% of cumulative infections by 2025, at an additional $39,900 per infection averted compared to baseline ART scale-up. PrEP targeted to 60\% of 20{\textendash}29-year-olds, in addition to baseline ART scale-up, reduced incidence by 42\% and averted 22\% of infections at an additional $22,500 per infection averted, whereas PrEP targeted to 80\% of high-risk individuals reduced incidence by 33\% and averted 13\% of infections at an additional $7,400 per infection averted. PrEP coverage of 20\% of the general population reduced incidence by 37\% and incident infections by 18\%, at an additional $26,900 per infection averted. Conclusion In a generalised HIV epidemic setting PrEP is a cost-effective addition to ART, with targeted PrEP being more cost-effective than generalised PrEP distribution.}, issn = {1368-4973}, URL = {https://sti.bmj.com/content/89/Suppl_1/A219.1}, eprint = {https://sti.bmj.com/content/89/Suppl_1/A219.1.full.pdf}, journal = {Sexually Transmitted Infections} }