Mathematical Model Impact Analysis of a Real-Life Pre-exposure Prophylaxis and Treatment-As-Prevention Study Among Female Sex Workers in Cotonou, Benin

Geidelberg, Lily; Mitchell, Kate; Alary, Michel; Mboup, Aminata; Béhanzin, Luc; Geraldo, Nassirou; Goma-Matsétsé, Ella; Giguère, Katia; Aza-Gnandji, Marlène; Kessou, Léon; Diallo, Mamadou O.; Kêkê, René K; Bachabi, Moussa; Kania, Dramane; Lafrance, Christian; Affolabi, Dissou; Diabaté, Souleymane; Gagnon, Marie‐Pierre; Zannou, Djimon Marcel; Gangbo, Flore; Silhol, Romain; Cianci, Fiona; Vickerman, Peter; Boily, Marie-Claude

doi:10.1097/qai.0000000000002535

Cited by 7 publications

(13 citation statements)

References 51 publications

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“…Only one previous study from sub‐Saharan Africa, which evaluated the impact of a PrEP demonstration project for FSW in Benin [ 9 ], has used real data from FSW on PrEP uptake, adherence and retention. This analysis projected that PrEP for FSWs could have a greater population‐level impact than we projected if much higher coverage levels were achieved.…”

Section: Discussionmentioning

confidence: 99%

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Impact and cost‐effectiveness of the national scale‐up of HIV pre‐exposure prophylaxis among female sex workers in South Africa: a modelling analysis

et al. 2023

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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. Going forward, existing coverage of PrEP will avert 5,635 (3,036) infections by 2040. However, if PrEP initiation and retention doubles, then PrEP coverage increases to 9.9% (8.7-11.6%) and impact increases 4.3 times with 24,114 (15,308-38,107) infections averted by 2040. Conclusions: Our findings advocate for the expansion of PrEP to FSWs throughout SA to maximize its impact. This should include strategies to optimize retention and should target women in contact with FSW services.

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Section: Discussionmentioning

confidence: 99%

“…A recent review of existing modelling and cost‐effectiveness studies of PrEP summarized that too few are informed by real‐world uptake, retention and adherence data and few use cost data from actual interventions [ 8 ]. For modelling PrEP among FSWs, only one study has utilized data from a real project [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Impact and cost‐effectiveness of the national scale‐up of HIV pre‐exposure prophylaxis among female sex workers in South Africa: a modelling analysis

et al. 2023

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“…For these analyses, we used 2 existing models specifically developed and calibrated to the population and HIV epidemiology of each setting. 61,62 The models are very similar, and the slight differences reflect the specific epidemiology and data available in each city. Table 1 shows the main characteristics of the HIV epidemics and levels of interventions, including among KPs.…”

Section: Methodsmentioning

confidence: 99%

“…The 2 models represented FSW (women reporting commercial sex as their major source of income), movement in and out of sex work [ending engagement in commercial sex and/or migration (Cotonou model only, information not available for FSW in Yaoundé)], 71 and their clients. Each risk group could form heterosexual noncommercial (main and casual) partnerships.…”

Section: Methodsmentioning

confidence: 99%

Assessing the Potential Impact of Disruptions Due to COVID-19 on HIV Among Key and Lower-Risk Populations in the Largest Cities of Cameroon and Benin

Silhol

Geidelberg

Mitchell

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…A number of combined HIV prevention programmes providing ART and health promotion and education activities for FSW in low- and middle-income countries have shown good results in terms of reducing risk behaviour, HIV/STI prevalence and cost-effectiveness [15-22]. However, the TasP/PrEP demonstration projects conducted in South Africa and Benin in 2014-2016were the first to examine the specific impact of TasP and PrEP among FSW [23, 24].…”

Section: Introductionmentioning

confidence: 99%

Modelling the cost-effectiveness of TasP and PrEP in female sex workers in Cotonou, Benin

Cianci,

Geidelberg,

Mitchell

et al. 2023

Preprint

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IntroductionTreatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) could impact the HIV epidemic among Female Sex Workers (FSW) but their cost-effectiveness is uncertain in this group. This study aims to model the cost-effectiveness of TasP and PrEP among FSW in Cotonou, Benin.MethodsA demonstration study assessed TasP and PrEP use among FSW in Cotonou. A dynamic HIV transmission model was developed to estimate the impact of this intervention and published elsewhere. Incremental economic costs of the study were collected prospectively capturing both provider and FSW costs. The incremental cost-effectiveness ratio per HIV infection and disability-adjusted life years (DALY) averted were estimated over a 20 year time horizon with costs converted to USD 2020 and both costs and DALYs discounted at 4.5% per year. Different cost scenarios were modelled to investigate the cost-effectiveness of the intervention as delivered by the government reflecting current day implementation and resource costs.ResultsThe mean provider annual economic cost per FSW on TasP was $646, with an initiation cost of $347 and mean annual user costs were $16. The mean initiation costs for PrEP were $268, mean annual provider costs were $359-$499 and annual user cost $15-$21 depending on adherence level. TasP was found to be cost saving for all cost scenarios examined compared to routine HIV care for FSW. PrEP was not cost-effective for any cost scenario, population coverage or adherence level examined.ConclusionOur results support TasP but not PrEP for FSW in our setting. A streamlined, outreach delivery model with reduced costs should be investigated to assess its cost-effectiveness in this setting.

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Mathematical Model Impact Analysis of a Real-Life Pre-exposure Prophylaxis and Treatment-As-Prevention Study Among Female Sex Workers in Cotonou, Benin

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 7 publications

References 51 publications

Impact and cost‐effectiveness of the national scale‐up of HIV pre‐exposure prophylaxis among female sex workers in South Africa: a modelling analysis

Impact and cost‐effectiveness of the national scale‐up of HIV pre‐exposure prophylaxis among female sex workers in South Africa: a modelling analysis

Assessing the Potential Impact of Disruptions Due to COVID-19 on HIV Among Key and Lower-Risk Populations in the Largest Cities of Cameroon and Benin

Modelling the cost-effectiveness of TasP and PrEP in female sex workers in Cotonou, Benin

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