The cost‐effectiveness of multi‐purpose HIV and pregnancy prevention technologies in South Africa

• Published in: Journal of the International AIDS Society 2018-03, Vol.21 (3), p.1-n/a
• Main Authors: Quaife, Matthew, Terris‐Prestholt, Fern, Eakle, Robyn, Cabrera Escobar, Maria A., Kilbourne‐Brook, Maggie, Mvundura, Mercy, Meyer‐Rath, Gesine, Delany‐Moretlwe, Sinead, Vickerman, Peter
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Antiviral agents; Clinical trials; Condoms; Contraception - economics; Contraception - methods; Cost benefit analysis; discrete choice experiments; Disease prevention; Dosage and administration; Drug delivery systems; Female; Females; Health aspects; HIV; HIV infection; HIV infections; HIV Infections - prevention & control; HIV prevention; Human immunodeficiency virus; Humans; key populations; Male; Methods; Middle Aged; multi‐purpose prevention; Population; Pre-Exposure Prophylaxis; Pregnancy; Pregnant women; Prevention; Prostitutes; R&D; Research & development; Risk factors; Sex Workers; Sexually transmitted diseases; South Africa; Womens health; Young Adult
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25064

Introduction A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi‐purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost‐effectiveness of combinations of candidate multi‐purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs). Methods We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost‐effectiveness of five candidate co‐formulated or co‐provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end‐users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability‐adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis. Results At central incidence rates, all single‐ and multi‐purpose scenarios modelled were cost‐effective among FSWs and women aged 16–24, at a governmental willingness‐to‐pay threshold of $1175/DALY averted (range: $214–$810/DALY averted among non‐dominant scenarios), however, none were cost‐effective among women aged 25–49 (minimum $1706/DALY averted). The cost‐effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters. Conclusions To the best of our knowledge, this is the first study to estimate the cost‐effectiveness of a range of potential MPTs; sugg