Potential cost-effectiveness of community availability of tenofovir, lamivudine, and dolutegravir for HIV prevention and treatment in east, central, southern, and west Africa: a modelling analysis
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Potential cost-effectiveness of community availability of tenofovir, lamivudine, and dolutegravir for HIV prevention and treatment in east, central, southern, and west Africa : a modelling analysis. / Phillips, Andrew N.; Bansi-Matharu, Loveleen; Shahmanesh, Maryam; Hargreaves, James R.; Smith, Jennifer; Revill, Paul; Sibanda, Euphemia; Ehrenkranz, Peter; Sikwese, Kenly; Rodger, Alison; Lundgren, Jens D.; Gilks, Charles F.; Godfrey, Catherine; Cowan, Frances; Cambiano, Valentina.
In: The Lancet Global Health, Vol. 11, No. 10, 2023, p. e1648-e1657.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Potential cost-effectiveness of community availability of tenofovir, lamivudine, and dolutegravir for HIV prevention and treatment in east, central, southern, and west Africa
T2 - a modelling analysis
AU - Phillips, Andrew N.
AU - Bansi-Matharu, Loveleen
AU - Shahmanesh, Maryam
AU - Hargreaves, James R.
AU - Smith, Jennifer
AU - Revill, Paul
AU - Sibanda, Euphemia
AU - Ehrenkranz, Peter
AU - Sikwese, Kenly
AU - Rodger, Alison
AU - Lundgren, Jens D.
AU - Gilks, Charles F.
AU - Godfrey, Catherine
AU - Cowan, Frances
AU - Cambiano, Valentina
N1 - Publisher Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2023
Y1 - 2023
N2 - Background: Post-exposure prophylaxis (PEP) offers protection from HIV after condomless sex, but is not widely available in a timely manner in east, central, southern, and west Africa. To inform the potential pilot implementation of such an approach, we modelled the effect and cost-effectiveness of making PEP consisting of tenofovir, lamivudine, and dolutegravir (TLD) freely and locally available in communities without prescription, with the aim of enabling PEP use within 24 h of condomless sex. Free community availability of TLD (referred to as community TLD) might also result in some use of TLD as pre-exposure prophylaxis (PrEP) and as antiretroviral therapy for people living with HIV. Methods: Using an existing individual-based model (HIV Synthesis), we explicitly modelled the potential positive and negative effects of community TLD. Through the sampling of parameter values we created 1000 setting-scenarios, reflecting the uncertainty in assumptions and a range of settings similar to those seen in east, central, southern, and west Africa (with a median HIV prevalence of 14·8% in women and 8·1% in men). For each setting scenario, we considered the effects of community TLD. TLD PEP was assumed to have at least 90% efficacy in preventing HIV infection after condomless sex with a person living with HIV. Findings: The modelled effects of community TLD availability based on an assumed high uptake of TLD resulted in a mean reduction in incidence of 31% (90% range over setting scenarios, 6% increase to 57% decrease) over 20 years, with an HIV incidence reduction over 50 years in 91% of the 1000 setting scenarios, deaths averted in 55% of scenarios, reduction in costs in 92% of scenarios, and disability-adjusted life-years averted in 64% of scenarios with community TLD. Community TLD was cost-effective in 90% of setting scenarios and cost-saving (with disability-adjusted life-years averted) in 58% of scenarios. When only examining setting scenarios in which there was lower uptake of community TLD, community TLD is cost-effective in 92% of setting scenarios. Interpretation: The introduction of community TLD, enabling greater PEP access, is a promising approach to consider further in pilot implementation projects. Funding: Bill & Melinda Gates Foundation to the HIV Modelling Consortium.
AB - Background: Post-exposure prophylaxis (PEP) offers protection from HIV after condomless sex, but is not widely available in a timely manner in east, central, southern, and west Africa. To inform the potential pilot implementation of such an approach, we modelled the effect and cost-effectiveness of making PEP consisting of tenofovir, lamivudine, and dolutegravir (TLD) freely and locally available in communities without prescription, with the aim of enabling PEP use within 24 h of condomless sex. Free community availability of TLD (referred to as community TLD) might also result in some use of TLD as pre-exposure prophylaxis (PrEP) and as antiretroviral therapy for people living with HIV. Methods: Using an existing individual-based model (HIV Synthesis), we explicitly modelled the potential positive and negative effects of community TLD. Through the sampling of parameter values we created 1000 setting-scenarios, reflecting the uncertainty in assumptions and a range of settings similar to those seen in east, central, southern, and west Africa (with a median HIV prevalence of 14·8% in women and 8·1% in men). For each setting scenario, we considered the effects of community TLD. TLD PEP was assumed to have at least 90% efficacy in preventing HIV infection after condomless sex with a person living with HIV. Findings: The modelled effects of community TLD availability based on an assumed high uptake of TLD resulted in a mean reduction in incidence of 31% (90% range over setting scenarios, 6% increase to 57% decrease) over 20 years, with an HIV incidence reduction over 50 years in 91% of the 1000 setting scenarios, deaths averted in 55% of scenarios, reduction in costs in 92% of scenarios, and disability-adjusted life-years averted in 64% of scenarios with community TLD. Community TLD was cost-effective in 90% of setting scenarios and cost-saving (with disability-adjusted life-years averted) in 58% of scenarios. When only examining setting scenarios in which there was lower uptake of community TLD, community TLD is cost-effective in 92% of setting scenarios. Interpretation: The introduction of community TLD, enabling greater PEP access, is a promising approach to consider further in pilot implementation projects. Funding: Bill & Melinda Gates Foundation to the HIV Modelling Consortium.
U2 - 10.1016/S2214-109X(23)00383-2
DO - 10.1016/S2214-109X(23)00383-2
M3 - Journal article
C2 - 37734807
AN - SCOPUS:85171269750
VL - 11
SP - e1648-e1657
JO - The Lancet Global Health
JF - The Lancet Global Health
SN - 2214-109X
IS - 10
ER -
ID: 397606595