| Autor: |
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, Revill, Paul |
| Předmět: |
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| Zdroj: |
Journal of Infectious Diseases; 4/15/2021, Vol. 223 Issue 8, p1345-1355, 11p |
| Abstrakt: |
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. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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