Imperial College London


Faculty of MedicineSchool of Public Health

Professor of Mathematical Epidemiology



+44 (0)20 7594 3263mc.boily




LG26Norfolk PlaceSt Mary's Campus






BibTex format

author = {Maheu-Giroux, M and Diabate, S and Boily, M-C and Jean-Paul, N and Vesga, J and Baral, S and Abo, K and Wognin, V and Diouf, D and Alary, M},
doi = {10.1097/QAI.0000000000001956},
journal = {JAIDS-Journal of Acquired Immune Deficiency Syndromes},
pages = {503--512},
title = {Cost-effectiveness of accelerated HIV response scenarios in Côte d’Ivoire},
url = {},
volume = {80},
year = {2019}

RIS format (EndNote, RefMan)

AB - Background: Despite Côte d’Ivoire epidemic being labelled as ‘generalized’, key populations (KP) are important to overall transmission. Using a dynamic model of HIV transmission, we previously estimated the impact of several treatment-as-prevention strategies that reached –or missed– the UNAIDS 90-90-90 targets in different populations groups, including KP and clients of female sex workers (CFSW). To inform program planning and resources allocation, we assessed the cost-effectiveness of these scenarios.Methods: Costing was performed from the provider’s perspective. Unit costs were obtained from the Ivorian Programme national de lutte contre le Sida (USD 2015) and discounted at 3%. Net incremental cost-effectiveness ratios (ICER) per adult HIV infection prevented and per disability-adjusted life years (DALY) averted were estimated over 2015-2030.Results: The three most cost-effective and affordable scenarios were the ones that projected current programmatic trends (ICER=$210; 90% uncertainty interval [90UI%]: $150-$300), attaining the 90-90-90 objectives among KP and CFSW (ICER=$220; 90%UI: $80-$510), and among KP only (ICER=$290; 90%UI: $90-$660). The least cost-effective scenario was the one that reached the UNAIDS 90-90-90 target accompanied by a 25% point drop in condom use in KP (ICER=$710; 90%UI: $450-$1,270). In comparison, the UNAIDS scenario had a net ICER of $570 (90%UI: $390-$900) per DALY averted.Conclusions: According to commonly used thresholds, accelerating the HIV response can be considered very cost-effective for all scenarios. However, when balancing epidemiological impact, cost-effectiveness, and affordability, scenarios that sustain both high condom use and rates of viral suppression among KP and CFSW appear most promising in Côte d’Ivoire.
AU - Maheu-Giroux,M
AU - Diabate,S
AU - Boily,M-C
AU - Jean-Paul,N
AU - Vesga,J
AU - Baral,S
AU - Abo,K
AU - Wognin,V
AU - Diouf,D
AU - Alary,M
DO - 10.1097/QAI.0000000000001956
EP - 512
PY - 2019///
SN - 1525-4135
SP - 503
TI - Cost-effectiveness of accelerated HIV response scenarios in Côte d’Ivoire
T2 - JAIDS-Journal of Acquired Immune Deficiency Syndromes
UR -
UR -
VL - 80
ER -