Lise Jamieson1,2, Gabriela B Gomez3, Kevin Rebe4, Ben Brown4, Hasina Subedar5, Sarah Jenkins6, Natsai Shoko7, Linda-Gail Bekker8, Leigh F Johnson9, Gesine Meyer-Rath1,2,10. 1. Health Economics and Epidemiology Research Office (HERO). 2. Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 3. Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom. 4. ANOVA Health Institute, Cape Town. 5. National Department of Health, Pretoria, South Africa. 6. Clinton Health Access Initiative, Philadelphia, USA. 7. Clinton Health Access Initiative, Pretoria. 8. Desmond Tutu HIV Centre, University of Cape Town. 9. Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa. 10. Department of Global Health, Boston University School of Public Health, Boston, USA.
Abstract
OBJECTIVES: We explored the impact and cost-effectiveness of preexposure prophylaxis (PrEP) provision to different populations in South Africa, with and without effective self-selection by individuals at highest risk of contracting HIV (through concurrent partnerships and/or commercial sex). DESIGN AND METHODS: We used a previously developed HIV transmission model to analyse the epidemiological impact of PrEP provision to adolescents, young adults, pregnant women, female sex workers (FSWs) and (MSM), and data from South African PrEP programmes to estimate the cost and cost-effectiveness of PrEP (cost in 2019 USD per HIV infection averted over 20 years, 2019, 38). PrEP uptake followed data from early implementation sites, scaled-up linearly over 3 years, with target coverage set to 18% for adolescents, young adults and pregnant women, 30% for FSW and 54% for MSM. RESULTS: The annual cost of PrEP provision ranges between $75 and $134 per person. PrEP provision adolescents and young adults, regardless of risk behaviour, will each avert 3.2--4.8% of HIV infections over 20 years; provision to high-risk individuals only has similar impact at lower total cost. The incremental cost per HIV infection averted is lower in high-risk vs. all-risk sub-populations within female adolescents ($507 vs. $4537), male adolescents ($2108 vs. $5637), young women ($1592 vs. $10 323) and young men ($2605 vs. $7715), becoming cost saving within 20 years for high-risk adolescents, young women, MSM and FSWs. CONCLUSION: PrEP is an expensive prevention intervention but uptake by those at the highest risk of HIV infection will make it more cost-effective, and cost-saving after 14-18 years.
OBJECTIVES: We explored the impact and cost-effectiveness of preexposure prophylaxis (PrEP) provision to different populations in South Africa, with and without effective self-selection by individuals at highest risk of contracting HIV (through concurrent partnerships and/or commercial sex). DESIGN AND METHODS: We used a previously developed HIV transmission model to analyse the epidemiological impact of PrEP provision to adolescents, young adults, pregnant women, female sex workers (FSWs) and (MSM), and data from South African PrEP programmes to estimate the cost and cost-effectiveness of PrEP (cost in 2019 USD per HIV infection averted over 20 years, 2019, 38). PrEP uptake followed data from early implementation sites, scaled-up linearly over 3 years, with target coverage set to 18% for adolescents, young adults and pregnant women, 30% for FSW and 54% for MSM. RESULTS: The annual cost of PrEP provision ranges between $75 and $134 per person. PrEP provision adolescents and young adults, regardless of risk behaviour, will each avert 3.2--4.8% of HIV infections over 20 years; provision to high-risk individuals only has similar impact at lower total cost. The incremental cost per HIV infection averted is lower in high-risk vs. all-risk sub-populations within female adolescents ($507 vs. $4537), male adolescents ($2108 vs. $5637), young women ($1592 vs. $10 323) and young men ($2605 vs. $7715), becoming cost saving within 20 years for high-risk adolescents, young women, MSM and FSWs. CONCLUSION: PrEP is an expensive prevention intervention but uptake by those at the highest risk of HIV infection will make it more cost-effective, and cost-saving after 14-18 years.
Authors: Andrew N 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; Debra Ten Brink; 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 Havlir; Maya Petersen; Moses Kamya; Catherine A Koss; Laura B Balzer; Tsitsi Apollo; Thato Chidarikire; John W Mellors; Urvi M Parikh; Catherine Godfrey; Valentina Cambiano Journal: Lancet HIV Date: 2022-05 Impact factor: 16.070