Imperial College London


Faculty of MedicineSchool of Public Health

Professor of Global Health



+44 (0)20 7594 1150timothy.hallett




Norfolk PlaceSt Mary's Campus






BibTex format

author = {Phillips, AN and Cambiano, V and Nakagawa, F and Revill, P and Jordan, MR and Hallett, TB and Doherty, M and De, Luca A and Lundgren, JD and Mhangara, M and Apollo, T and Mellors, J and Nichols, B and Parikh, U and Pillay, D and de, Wit TR and Sigaloff, K and Havlir, D and Kuritzkes, DR and Pozniak, A and van, de Vijver D and Vitoria, M and Wainberg, MA and Raizes, E and Bertagnolio, S},
doi = {10.1016/S2352-3018(17)30190-X},
journal = {LANCET HIV},
pages = {E146--E154},
title = {Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study},
url = {},
volume = {5},
year = {2018}

RIS format (EndNote, RefMan)

AB - BackgroundThere is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high.MethodsThe HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year.FindingsA transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost.InterpretationA future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to
AU - Phillips,AN
AU - Cambiano,V
AU - Nakagawa,F
AU - Revill,P
AU - Jordan,MR
AU - Hallett,TB
AU - Doherty,M
AU - De,Luca A
AU - Lundgren,JD
AU - Mhangara,M
AU - Apollo,T
AU - Mellors,J
AU - Nichols,B
AU - Parikh,U
AU - Pillay,D
AU - de,Wit TR
AU - Sigaloff,K
AU - Havlir,D
AU - Kuritzkes,DR
AU - Pozniak,A
AU - van,de Vijver D
AU - Vitoria,M
AU - Wainberg,MA
AU - Raizes,E
AU - Bertagnolio,S
DO - 10.1016/S2352-3018(17)30190-X
EP - 154
PY - 2018///
SN - 2352-3018
SP - 146
TI - Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study
UR -
UR -
UR -
VL - 5
ER -