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Dapivirine vaginal ring for HIV prevention: modelling health outcomes, drug resistande and cost-effectiveness
- Source :
- Journal of the International AIDS Society. May, 2019, Vol. 22 Issue 5, p1c, 11 p.
- Publication Year :
- 2019
-
Abstract
- Introduction: A vaginal ring containing dapivirine is effective for HIV prevention as pre-exposure prophylaxis (PrEP). We evaluated the potential epidemiological impact and cost-effectiveness of dapivirine vaginal ring PrEP among 22- to 45-year-old women in KwaZulu-Natal, South Africa. Methods: Using mathematical modelling, we studied dapivirine vaginal ring PrEP implementation, either unprioritized, or prioritized based on HIV incidence (>3% per year), age (22 to 29 years) or female sex worker status, alongside the implementation of voluntary medical male circumcision and antiretroviral therapy scaled-up to UNAIDS Fast-Track targets. Outcomes over the intervention (2019 to 2030) and lifetime horizons included cumulative HIV infections, life-years lived, costs and cost-effectiveness. We assessed the incremental cost-effectiveness ratios against the revealed willingness to pay ($500) and the standard (2017 per capita gross domestic product; $6161) cost-effectiveness thresholds for South Africa. Results: Compared to a reference scenario without PrEP, implementation of dapivirine vaginal ring PrEP, assuming 56% effectiveness and covering 50% of 22 to 29-year-old or high-incidence women, prevented 10% or 11% of infections by 2030 respectively. Equivalent, unprioritized coverage (30%) prevented fewer infections (7%), whereas 50% coverage of female sex workers had the least impact (4%). Drug resistande attributable to PrEP was modest (2% to 4% of people living with drug-resistant HIV). Over the lifetime horizon, dapivirine PrEP implementation among female sex workers was cost-saving, whereas incidence-based PrEP cost $1898 per life-year gained, relative to PrEP among female sex workers and $989 versus the reference scenario. In a scenario of 37% PrEP effectiveness, PrEP had less impact, but prioritization to female sex workers remained cost-saving. In uncertainty analysis, female sex worker PrEP was consistently cost-saving; and over the lifetime horizon, PrEP cost less than $6161 per life-year gained in over 99% of simulations, whereas incidence- and age-based PrEP cost below $500 per life-year gained in 61% and 49% of simulations respectively. PrEP adherence and efficacy, and the effectiveness of antiretroviral therapy for HIV prevention, were the principal drivers of uncertainty in the cost-effectiveness of PrEP. Conclusions: Dapivirine vaginal ring PrEP would be cost-saving in KwaZulu-Natal if prioritized to female sex workers. PrEP's impact on HIV prevention would be increased, with potential affordability if prioritized to women by age or incidence. Keywords: HIV prevention; pre-exposure prophylaxis/Preexposure prophylaxis/PrEP; dapivirine/DPV; vaginal ring; cost-effectiveness; drug resistande; mathematical mode<br />1 | INTRODUCTION Pre-exposure prophylaxis (PrEP), the use of antiretrovirals by HIV-negative individuals to block HIV acquisition, is promising for HIV prevention. Oral PrEP is protective across populations, including men [...]
- Subjects :
- Highly active antiretroviral therapy -- Economic aspects -- Analysis -- Health aspects
HIV infections -- Prevention -- Economic aspects -- Analysis -- Health aspects
Emtricitabine -- Economic aspects -- Analysis -- Health aspects
Microbial drug resistance -- Prevention -- Economic aspects -- Analysis -- Health aspects
HIV -- Prevention -- Economic aspects -- Analysis -- Health aspects
Infection -- Prevention -- Economic aspects -- Analysis -- Health aspects
Epidemiology -- Economic aspects -- Analysis -- Health aspects
Sexually transmitted disease prevention -- Economic aspects -- Analysis -- Health aspects
Sex oriented businesses -- Economic aspects -- Analysis -- Health aspects
Circumcision -- Economic aspects -- Analysis -- Health aspects
Health
United Nations
World Health Organization
Subjects
Details
- Language :
- English
- ISSN :
- 17582652
- Volume :
- 22
- Issue :
- 5
- Database :
- Gale General OneFile
- Journal :
- Journal of the International AIDS Society
- Publication Type :
- Academic Journal
- Accession number :
- edsgcl.593676153
- Full Text :
- https://doi.org/10.1002/jia2.25282