Potential Impact and Cost-Effectiveness of Condomless-Sex-Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance

Phillips, Andrew N, Cambiano, Valentina, Johnson, Leigh , Nakagawa, Fumiyo, Homan, Rick, Meyer-Rath, Gesine, Rehle, Thomas, Tanser, Frank, Moyo, Sizulu, Shahmanesh, Maryam, Castor, Delivette, Russell, Elizabeth, Jamieson, Lise, Bansi-Matharu, Loveleen, Shroufi, Amir, Barnabas, Ruanne V, Parikh, Urvi M, Mellors, John W and Revill, Paul (2021) Potential Impact and Cost-Effectiveness of Condomless-Sex-Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance. The Journal of Infectious Diseases .

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Item Type:Article
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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.

Keywords:HIV; PrEP; South Africa; cost; cost-effectiveness analysis; drug resistance; individual-based; model.
Divisions:College of Social Science > Lincoln International Institute for Rural Health
ID Code:45229
Deposited On:09 Jun 2021 14:14

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