RT Journal Article
SR Electronic
T1 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
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP A219
OP A219
DO 10.1136/sextrans-2013-051184.0683
VO 89
IS Suppl 1
A1 R Ying
A1 C Celum
A1 J Baeten
A1 P Murnane
A1 T Hong
A1 M Krows
A1 H van Rooyen
A1 H Humphries
A1 J P Hughes
A1 R Barnabas
YR 2013
UL http://sti.bmj.com/content/89/Suppl_1/A219.1.abstract
AB 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 ‘test and treat’ 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 ‘Test and treat’ (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 20–29-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.