Imperial College London
Alternate

ProfessorMarie-ClaudeBoily

Faculty of Medicine, School of Public Health

Professor of Mathematical Epidemiology
 
 
 
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Contact

 

+44 (0)20 7594 3263mc.boily

 
 
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Location

 

LG26Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Stone:2023:10.1002/jia2.26063,
author = {Stone, J and Bothma, R and Gomez, GB and Eakle, R and Mukandavire, C and Subedar, H and Fraser, H and Boily, M-C and Schwartz, S and Coetzee, J and Otwombe, K and Milovanovic, M and Baral, S and Johnson, LF and Venter, WDF and Rees, H and Vickerman, P},
doi = {10.1002/jia2.26063},
journal = {Journal of the International AIDS Society},
pages = {1--12},
title = {Impact and cost-effectiveness of the national scale-up of HIV pre-exposure prophylaxis among female sex workers in South Africa: a modelling analysis.},
url = {http://dx.doi.org/10.1002/jia2.26063},
volume = {26},
year = {2023}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - INTRODUCTION: In 2016, South Africa (SA) initiated a national programme to scale-up pre-exposure prophylaxis (PrEP) among female sex workers (FSWs), with ∼20,000 PrEP initiations among FSWs (∼14% of FSW) by 2020. We evaluated the impact and cost-effectiveness of this programme, including future scale-up scenarios and the potential detrimental impact of the COVID-19 pandemic. METHODS: A compartmental HIV transmission model for SA was adapted to include PrEP. Using estimates on self-reported PrEP adherence from a national study of FSW (67.7%) and the Treatment and Prevention for FSWs (TAPS) PrEP demonstration study in SA (80.8%), we down-adjusted TAPS estimates for the proportion of FSWs with detectable drug levels (adjusted range: 38.0-70.4%). The model stratified FSW by low (undetectable drug; 0% efficacy) and high adherence (detectable drug; 79.9%; 95% CI: 67.2-87.6% efficacy). FSWs can transition between adherence levels, with lower loss-to-follow-up among highly adherent FSWs (aHR: 0.58; 95% CI: 0.40-0.85; TAPS data). The model was calibrated to monthly data on the national scale-up of PrEP among FSWs over 2016-2020, including reductions in PrEP initiations during 2020. The model projected the impact of the current programme (2016-2020) and the future impact (2021-2040) at current coverage or if initiation and/or retention are doubled. Using published cost data, we assessed the cost-effectiveness (healthcare provider perspective; 3% discount rate; time horizon 2016-2040) of the current PrEP provision. RESULTS: Calibrated to national data, model projections suggest that 2.1% of HIV-negative FSWs were currently on PrEP in 2020, with PrEP preventing 0.45% (95% credibility interval, 0.35-0.57%) of HIV infections among FSWs over 2016-2020 or 605 (444-840) infections overall. Reductions in PrEP initiations in 2020 possibly reduced infections averted by 18.57% (13.99-23.29). PrEP is cost-saving, with $1.42 (1.03-1.99) of ART costs saved per dollar spent on PrEP.
AU  - Stone,J
AU  - Bothma,R
AU  - Gomez,GB
AU  - Eakle,R
AU  - Mukandavire,C
AU  - Subedar,H
AU  - Fraser,H
AU  - Boily,M-C
AU  - Schwartz,S
AU  - Coetzee,J
AU  - Otwombe,K
AU  - Milovanovic,M
AU  - Baral,S
AU  - Johnson,LF
AU  - Venter,WDF
AU  - Rees,H
AU  - Vickerman,P
DO  - 10.1002/jia2.26063
EP  - 12
PY  - 2023///
SN  - 1758-2652
SP  - 1
TI  - Impact and cost-effectiveness of the national scale-up of HIV pre-exposure prophylaxis among female sex workers in South Africa: a modelling analysis.
T2  - Journal of the International AIDS Society
UR  - http://dx.doi.org/10.1002/jia2.26063
UR  - https://www.ncbi.nlm.nih.gov/pubmed/36807874
UR  - https://onlinelibrary.wiley.com/doi/10.1002/jia2.26063
UR  - http://hdl.handle.net/10044/1/102883
VL  - 26
ER  -
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