Potential impact and cost-effectiveness of condomless-sex-concentrated PrEP in KwaZulu-Natal accounting for drug resistance
Authors
Revill, PaulPhillips, A
Cambiano, V
Johnson, L
Homan, R
Nakagawa, F
Meyer-Rath, G
Tanser, F
Rehle, T
Moyo, S
Russell, E
Castor, D
Shamanesh, M
Shroufi, A
Jamieson, L
Bansi-Matharu, L
Barnabas, R
Parikh, U
Mellors, J
Affiliation
MSF Cape TownIssue Date
2019-12-18Submitted date
2019-12-23
Metadata
Show full item recordJournal
Journal of Infectious DiseasesAbstract
Abstract INTRODUCTION: Oral pre-exposure 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 (i) PrEP availability for adolescent-girls-and-young-women (aged 15-24; AGYW) and female sex workers (FSW), and (ii) availability for everyone aged 15-64. Our primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programmes. RESULTS: In the context of PrEP use in adults aged 15-64 there was a predicted 33% reduction in incidence, and 36% reduction in women aged 15-24. 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.Publisher
Oxford University Press (OUP)Type
journal-articleLanguage
enISSN
0022-18991537-6613
ae974a485f413a2113503eed53cd6c53
10.1093/infdis/jiz667