Imperial College London
Alternate

Dr Kelsey Case

Faculty of Medicine, School of Public Health

Honorary Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 1524k.case

 
 
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Location

 

LG33BPraed StreetSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Phillips:2022:10.1016/S2352-3018(22)00029-7,
author = {Phillips, AN and Bershteyn, A and Revill, P and Bansi-Matharu, L and Kripke, K and Boily, M-C and Martin-Hughes, R and Johnson, LF and Mukandavire, Z and Jamieson, L and Meyer-Rath, G and Hallett, TB and Ten, Brink D and Kelly, SL and Nichols, BE and Bendavid, E and Mudimu, E and Taramusi, I and Smith, J and Dalal, S and Baggaley, R and Crowley, S and Terris-Prestholt, F and Godfrey-Faussett, P and Mukui, I and Jahn, A and Case, KK and Havlir, D and Petersen, M and Kamya, M and Koss, CA and Balzer, LB and Apollo, T and Chidarikire, T and Mellors, JW and Parikh, UM and Godfrey, C and Cambiano, V and HIV, Modelling Consortium},
doi = {10.1016/S2352-3018(22)00029-7},
journal = {The Lancet HIV},
pages = {e353--e362},
title = {Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study.},
url = {http://dx.doi.org/10.1016/S2352-3018(22)00029-7},
volume = {9},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Approaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead to lower HIV incidence, but their cost-effectiveness is unknown. We aimed to evaluate conditions under which risk-informed PrEP use is cost-effective. METHODS: We applied a mathematical model of HIV transmission to simulate 3000 setting-scenarios reflecting a range of epidemiological characteristics of communities in sub-Saharan Africa. The prevalence of HIV viral load greater than 1000 copies per mL among all adults (HIV positive and negative) varied from 1·1% to 7·4% (90% range). We hypothesised that if PrEP was made easily available without restriction and with education regarding its use, women and men would use PrEP, with sufficient daily adherence, during so-called seasons of risk (ie, periods in which individuals are at risk of acquiring infection). We refer to this as risk-informed PrEP. For each setting-scenario, we considered the situation in mid-2021 and performed a pairwise comparison of the outcomes of two policies: immediate PrEP scale-up and then continuation for 50 years, and no PrEP. We estimated the relationship between epidemic and programme characteristics and cost-effectiveness of PrEP availability to all during seasons of risk. For our base-case analysis, we assumed a 3-monthly PrEP cost of US$29 (drug $11, HIV test $4, and $14 for additional costs necessary to facilitate education and access), a cost-effectiveness threshold of $500 per disability-adjusted life-year (DALY) averted, an annual discount rate of 3%, and a time horizon of 50 years. In sensitivity analyses, we considered a cost-effectiveness threshold of $100 per DALY averted, a discount rate of 7% per annum, the use of PrEP outside of seasons of risk, and reduced uptake of risk-informed PrEP. FINDINGS: In the context of PrEP scale-up such that 66% (90% range across setting-scenarios 46-81) o
AU  - Phillips,AN
AU  - Bershteyn,A
AU  - Revill,P
AU  - Bansi-Matharu,L
AU  - Kripke,K
AU  - Boily,M-C
AU  - Martin-Hughes,R
AU  - Johnson,LF
AU  - Mukandavire,Z
AU  - Jamieson,L
AU  - Meyer-Rath,G
AU  - Hallett,TB
AU  - Ten,Brink D
AU  - Kelly,SL
AU  - Nichols,BE
AU  - Bendavid,E
AU  - Mudimu,E
AU  - Taramusi,I
AU  - Smith,J
AU  - Dalal,S
AU  - Baggaley,R
AU  - Crowley,S
AU  - Terris-Prestholt,F
AU  - Godfrey-Faussett,P
AU  - Mukui,I
AU  - Jahn,A
AU  - Case,KK
AU  - Havlir,D
AU  - Petersen,M
AU  - Kamya,M
AU  - Koss,CA
AU  - Balzer,LB
AU  - Apollo,T
AU  - Chidarikire,T
AU  - Mellors,JW
AU  - Parikh,UM
AU  - Godfrey,C
AU  - Cambiano,V
AU  - HIV,Modelling Consortium
DO  - 10.1016/S2352-3018(22)00029-7
EP  - 362
PY  - 2022///
SN  - 2405-4704
SP  - 353
TI  - Cost-effectiveness of easy-access, risk-informed oral pre-exposure prophylaxis in HIV epidemics in sub-Saharan Africa: a modelling study.
T2  - The Lancet HIV
UR  - http://dx.doi.org/10.1016/S2352-3018(22)00029-7
UR  - https://www.ncbi.nlm.nih.gov/pubmed/35489378
UR  - https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(22)00029-7/fulltext
UR  - http://hdl.handle.net/10044/1/97048
VL  - 9
ER  -
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