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Cost-effectiveness of pre-exposure prophylaxis targeted to high-risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda.
J Int AIDS Soc. 2015; 18(4 Suppl 3):20013.JI

Abstract

INTRODUCTION

Despite scale-up of antiretroviral therapy (ART) for treating HIV-positive persons, HIV incidence remains elevated among those at high risk such as persons in serodiscordant partnerships. Antiretrovirals taken by HIV-negative persons as pre-exposure prophylaxis (PrEP) has the potential to avert infections in individuals in serodiscordant partnerships. Evaluating the cost-effectiveness of implementing time-limited PrEP as a short-term bridge during the first six months of ART for the HIV-positive partner to prevent HIV transmission compared to increasing ART coverage is crucial to informing policy-makers considering PrEP implementation.

METHODS

To estimate the real world delivery costs of PrEP, we conducted micro-costing and time and motion analyses in an open-label prospective study of PrEP and ART delivery targeted to high-risk serodiscordant couples in Uganda (the Partners Demonstration Project). The cost (in USD, in 2012) of PrEP and ART for serodiscordant couples was assessed, with and without research components, in the study setting. Using Ministry of Health costs, the cost of PrEP and ART provision within a government programme was estimated, as was the cost of providing PrEP in addition to ART. We parameterized an HIV transmission model to estimate the health and economic impacts of 1) PrEP and ART targeted to high-risk serodiscordant couples in the context of current ART use and 2) increasing ART coverage to 55% of HIV-positive persons with CD4 ≤500 cells/µL without PrEP. The incremental cost-effectiveness ratios (ICERs) per HIV infection and disability-adjusted life year (DALY) averted were calculated over 10 years.

RESULTS

The annual cost of PrEP and ART delivery for serodiscordant couples was $1058 per couple in the study setting and $453 in the government setting. The portion of the programme cost due to PrEP was $408 and $92 per couple per year in the study and government settings, respectively. Over 10 years, a programme of PrEP and ART for high-risk serodiscordant couples was projected to avert 43% of HIV infections compared to current practice with an ICER of $1340 per infection averted. This was comparable to ART expansion alone, which would avert 37% of infections with an ICER of $1452.

CONCLUSIONS

Using Uganda's gross domestic product per capita of $1681 as a threshold, PrEP and ART for high-risk persons have the potential for synergistic action and are cost-effective in preventing HIV infections in high prevalence settings. The annual cost of PrEP in this programme is less than $100 per serodiscordant couple if implemented in public clinics.

Authors+Show Affiliations

Department of Global Health, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA. Department of Epidemiology, University of Washington, Seattle, WA, USA. Department of Medicine, University of Washington, Seattle, WA, USA.Department of Global Health, University of Washington, Seattle, WA, USA. Department of Epidemiology, University of Washington, Seattle, WA, USA. Department of Medicine, University of Washington, Seattle, WA, USA.Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda.Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda.Department of Global Health, University of Washington, Seattle, WA, USA. Department of Epidemiology, University of Washington, Seattle, WA, USA. Department of Medicine, University of Washington, Seattle, WA, USA. Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; rbarnaba@uw.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

26198348

Citation

Ying, Roger, et al. "Cost-effectiveness of Pre-exposure Prophylaxis Targeted to High-risk Serodiscordant Couples as a Bridge to Sustained ART Use in Kampala, Uganda." Journal of the International AIDS Society, vol. 18, no. 4 Suppl 3, 2015, p. 20013.
Ying R, Sharma M, Heffron R, et al. Cost-effectiveness of pre-exposure prophylaxis targeted to high-risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda. J Int AIDS Soc. 2015;18(4 Suppl 3):20013.
Ying, R., Sharma, M., Heffron, R., Celum, C. L., Baeten, J. M., Katabira, E., Bulya, N., & Barnabas, R. V. (2015). Cost-effectiveness of pre-exposure prophylaxis targeted to high-risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda. Journal of the International AIDS Society, 18(4 Suppl 3), 20013. https://doi.org/10.7448/IAS.18.4.20013
Ying R, et al. Cost-effectiveness of Pre-exposure Prophylaxis Targeted to High-risk Serodiscordant Couples as a Bridge to Sustained ART Use in Kampala, Uganda. J Int AIDS Soc. 2015;18(4 Suppl 3):20013. PubMed PMID: 26198348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of pre-exposure prophylaxis targeted to high-risk serodiscordant couples as a bridge to sustained ART use in Kampala, Uganda. AU - Ying,Roger, AU - Sharma,Monisha, AU - Heffron,Renee, AU - Celum,Connie L, AU - Baeten,Jared M, AU - Katabira,Elly, AU - Bulya,Nulu, AU - Barnabas,Ruanne V, Y1 - 2015/07/20/ PY - 2015/01/16/received PY - 2015/03/24/revised PY - 2015/04/15/accepted PY - 2015/7/23/entrez PY - 2015/7/23/pubmed PY - 2016/4/1/medline KW - ART KW - PrEP KW - cost-effectiveness analysis KW - mathematical modelling KW - serodiscordant couples SP - 20013 EP - 20013 JF - Journal of the International AIDS Society JO - J Int AIDS Soc VL - 18 IS - 4 Suppl 3 N2 - INTRODUCTION: Despite scale-up of antiretroviral therapy (ART) for treating HIV-positive persons, HIV incidence remains elevated among those at high risk such as persons in serodiscordant partnerships. Antiretrovirals taken by HIV-negative persons as pre-exposure prophylaxis (PrEP) has the potential to avert infections in individuals in serodiscordant partnerships. Evaluating the cost-effectiveness of implementing time-limited PrEP as a short-term bridge during the first six months of ART for the HIV-positive partner to prevent HIV transmission compared to increasing ART coverage is crucial to informing policy-makers considering PrEP implementation. METHODS: To estimate the real world delivery costs of PrEP, we conducted micro-costing and time and motion analyses in an open-label prospective study of PrEP and ART delivery targeted to high-risk serodiscordant couples in Uganda (the Partners Demonstration Project). The cost (in USD, in 2012) of PrEP and ART for serodiscordant couples was assessed, with and without research components, in the study setting. Using Ministry of Health costs, the cost of PrEP and ART provision within a government programme was estimated, as was the cost of providing PrEP in addition to ART. We parameterized an HIV transmission model to estimate the health and economic impacts of 1) PrEP and ART targeted to high-risk serodiscordant couples in the context of current ART use and 2) increasing ART coverage to 55% of HIV-positive persons with CD4 ≤500 cells/µL without PrEP. The incremental cost-effectiveness ratios (ICERs) per HIV infection and disability-adjusted life year (DALY) averted were calculated over 10 years. RESULTS: The annual cost of PrEP and ART delivery for serodiscordant couples was $1058 per couple in the study setting and $453 in the government setting. The portion of the programme cost due to PrEP was $408 and $92 per couple per year in the study and government settings, respectively. Over 10 years, a programme of PrEP and ART for high-risk serodiscordant couples was projected to avert 43% of HIV infections compared to current practice with an ICER of $1340 per infection averted. This was comparable to ART expansion alone, which would avert 37% of infections with an ICER of $1452. CONCLUSIONS: Using Uganda's gross domestic product per capita of $1681 as a threshold, PrEP and ART for high-risk persons have the potential for synergistic action and are cost-effective in preventing HIV infections in high prevalence settings. The annual cost of PrEP in this programme is less than $100 per serodiscordant couple if implemented in public clinics. SN - 1758-2652 UR - https://www.unboundmedicine.com/medline/citation/26198348/Cost_effectiveness_of_pre_exposure_prophylaxis_targeted_to_high_risk_serodiscordant_couples_as_a_bridge_to_sustained_ART_use_in_Kampala_Uganda_ L2 - https://doi.org/10.7448/IAS.18.4.20013 DB - PRIME DP - Unbound Medicine ER -