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Where to deploy pre-exposure prophylaxis (PrEP) in sub-Saharan Africa?
Stéphane Verguet1, Meg Stalcup, Julia A Walsh
1Department of Global Health, University of Washington, , Seattle, Washington, USA.
Sexually Transmitted Infections
|August 6, 2013
Summary
Pre-exposure prophylaxis (PrEP) can prevent 390,000 HIV infections in sub-Saharan Africa over 5 years. This high-cost intervention is most cost-effective in countries with high HIV burden and low male circumcision rates.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Pre-exposure prophylaxis (PrEP) has demonstrated efficacy in reducing HIV transmission among heterosexual individuals.
- Sub-Saharan Africa faces a significant HIV burden, necessitating effective prevention strategies.
Purpose of the Study:
- To model the potential impact of a 5-year PrEP intervention on HIV transmission in sub-Saharan Africa.
- To assess the cost-effectiveness of providing PrEP in this region, considering existing interventions.
Main Methods:
- A deterministic, compartmental model of HIV transmission was employed.
- The model evaluated a 5-year PrEP intervention targeting the adult population across 42 sub-Saharan African countries.
- Analysis considered the incremental impact of PrEP alongside male circumcision and antiretroviral therapy (ART), with assumed efficacy, adherence, coverage, and costs.
Main Results:
- An estimated 390,000 HIV infections could be averted over 5 years, with 24% in South Africa.
- The number of infections averted per 100,000 adults varied significantly by country, from 500 in Lesotho to 10 in Somalia.
- Incremental cost-effectiveness was estimated at US$5800/DALY, with country-level cost-effectiveness ranging from US$500/DALY in Lesotho to US$44,600/DALY in Eritrea.
Conclusions:
- PrEP is a high-cost intervention with maximum impact and cost-effectiveness in populations with high HIV burden and low male circumcision rates.
- PrEP is likely to be most effective in Southern Africa as a targeted addition to existing HIV control strategies.
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