Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study

作者：Andrew Phillips, Anna Bershteyn, Paul Revill, Loveleen Bansi‐Matharu, Katharine Kripke, Marie‐Claude Boily, Rowan Martin‐Hughes, Leigh F. Johnson, Zindoga Mukandavire, Lise Jamieson, Gesine Meyer‐Rath, Timothy B. Hallett, Brink, Debra ten, Sherrie L. Kelly, Brooke E Nichols, Eran Bendavid, Edinah Mudimu, Isaac Taramusi, Jennifer Smith, Shona Dalal, Rachel Baggaley, Siobhan Crowley, Fern Terris‐Prestholt, Peter Godfrey‐Faussett, Irene Mukui, Andreas Jahn, Kelsey K. Case, Diane V. Havlir, Maya L. Petersen, Moses R. Kamya, Catherine A. Koss, Laura B. Balzer, Tsitsi Apollo, Thato Chidarikire, John W. Mellors, Urvi M. Parikh, Catherine Godfrey, Valentina Cambiano, Consortium, HIV Modelling · 发表于：White Rose Research Online (University of Leeds, The University of Sheffield, University of York) · 年份：2022 · 被引用次数：38 · 研究领域：HIV/AIDS Research and Interventions、HIV, Drug Use, Sexual Risk、Pneumocystis jirovecii pneumonia detection and treatment

BackgroundApproaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead to lower HIV incidence, but their cost-effectiveness is unknown. We aimed to evaluate conditions under which risk-informed PrEP use is cost-effective.MethodsWe applied a mathematical model of HIV transmission to simulate 3000 setting-scenarios reflecting a range of epidemiological characteristics of communities in sub-Saharan Africa. The prevalence of HIV viral load greater than 1000 copies per mL among all adults (HIV positive and negative) varied from 1·1% to 7·4% (90% range). We hypothesised that if PrEP was made easily available without restriction and with education regarding its use, women and men would use PrEP, with sufficient daily adherence, during so-called seasons of risk (ie, periods in which individuals are at risk of acquiring infection). We refer to this as risk-informed PrEP. For each setting-scenario, we considered the situation in mid-2021 and performed a pairwise comparison of the outcomes of two policies: immediate PrEP scale-up and then continuation for 50 years, and no PrEP. We estimated the relationship between epidemic and programme characteristics and cost-effectiveness of PrEP availability to all during seasons of risk. For our base-case analysis, we assumed a 3-monthly PrEP cost of US$29 (drug $11, HIV test $4, and $14 for additional costs necessary to facilitate education...