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Potential impact and cost-effectiveness of condomless-sex-concentrated PrEP in KwaZulu-Natal accounting for drug resistance.
The Journal of Infectious Diseases ( IF 6.4 ) Pub Date : 2019-12-18 , DOI: 10.1093/infdis/jiz667
Andrew N Phillips 1 , Valentina Cambiano 1 , Leigh Johnson 2 , Fumiyo Nakagawa 1 , Rick Homan 3 , Gesine Meyer-Rath 4, 5, 6 , Thomas Rehle 2 , Frank Tanser 7, 8, 9, 10 , Sizulu Moyo 11 , Maryam Shahmanesh 1, 8 , Delivette Castor 12 , Elizabeth Russell 12 , Lise Jamieson 4, 5 , Loveleen Bansi-Matharu 1 , Amir Shroufi 13 , Ruanne V Barnabas 14 , Urvi M Parikh 15 , John W Mellors 15 , Paul Revill 16
Affiliation  

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.

中文翻译:

夸祖鲁-纳塔尔省无避孕套性浓缩 PrEP 的潜在影响和成本效益说明了耐药性。

简介 正在南非的选定地点实施替诺福韦-地索普西-富马酸盐/恩曲他滨形式的口服暴露前预防 (PrEP)。解决有关 PrEP 成本效益的悬而未决的问题可以为进一步的实施提供信息。方法 我们针对 KwaZulu-Natal 校准了一个基于个体的模型,以预测 PrEP 的影响和成本效益,使用集中在无安全套性行为期间,考虑到对耐药性的影响。我们考虑 (i) 少女和年轻女性(15-24 岁;AGYW)和女性性工作者 (FSW) 的 PrEP 可用性,以及 (ii) 15-64 岁的每个人的可用性。我们的主要分析代表了假设未来 PrEP 计划可达到的 PrEP 使用水平。结果 在 15-64 岁成人使用 PrEP 的情况下,预计发病率降低 33%,15-24 岁的女性减少 36%。PrEP 具有成本效益,包括在一系列敏感性分析中,尽管由于 PrEP 通过增加 HIV 耐药性破坏了 ART 有效性,因此在使用依非韦伦而不是基于多替拉韦的 ART 启动政策下,(成本)有效性大大降低。结论 在无安全套性行为期间集中使用 PrEP 有可能对 HIV 发病率产生实质性影响并且具有成本效益。
更新日期:2019-12-19
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