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    Jan 23, 2021
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    Potential impact and cost-effectiveness of condomless-sex-concentrated PrEP in KwaZulu-Natal accounting for drug resistance

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    Phillips et al 2019 Potential ...
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    Authors
    Revill, Paul
    Phillips, 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
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    Affiliation
    MSF Cape Town
    Issue Date
    2019-12-18
    Submitted date
    2019-12-23
    
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    Journal
    Journal of Infectious Diseases
    Abstract
    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)
    URI
    http://hdl.handle.net/10144/619571
    DOI
    10.1093/infdis/jiz667
    Type
    journal-article
    Language
    en
    ISSN
    0022-1899
    1537-6613
    ae974a485f413a2113503eed53cd6c53
    10.1093/infdis/jiz667
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