Maximizing the benefits of ART and PrEP in resource-limited settings

Akudibillah, Gordon; Pandey, Abhishek; Medlock, Jan

doi:10.1017/s0950268816002958

Cited by 16 publications

(10 citation statements)

References 28 publications

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“…These studies span from 2007 to 2017 with 42 studies modelling oral PrEP in sub‐Saharan Africa and two studies with non‐specific settings but of relevance for generalized HIV epidemics. Applications of country‐specific modelling of oral PrEP occurred predominantly for South Africa and Kenya , followed by Botswana , Zambia , and one application each for Zimbabwe , Mozambique , Nigeria , and Uganda . Select country‐specific results were additionally presented in two studies .…”

Section: Resultsmentioning

confidence: 99%

The impact, cost and cost‐effectiveness of oral pre‐exposure prophylaxis in sub‐Saharan Africa: a scoping review of modelling contributions and way forward

2019

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Introduction Oral pre‐exposure prophylaxis (PrEP) is a new form of HIV prevention being considered for inclusion in national prevention portfolios. Many mathematical modelling studies have been undertaken that speak to the impact, cost and cost‐effectiveness of PrEP programmes. We assess the available evidence from mathematical modelling studies to inform programme planning and policy decision making for PrEP and further research directions. Methods We conducted a scoping review of the published modelling literature. Articles published in English which modelled oral PrEP in sub‐Saharan Africa, or non‐specific settings with relevance to generalized HIV epidemic settings, were included. Data were extracted for the strategies of PrEP use modelled, and the impact, cost and cost‐effectiveness of PrEP for each strategy. We define an algorithm to assess the quality and relevance of studies included, summarize the available evidence and identify the current gaps in modelling. Recommendations are generated for future modelling applications and data collection. Results and Discussion We reviewed 1924 abstracts and included 44 studies spanning 2007 to 2017. Modelling has reported that PrEP can be a cost‐effective addition to HIV prevention portfolios for some use cases, but also that it would not be cost‐effective to fund PrEP before other prevention interventions are expanded. However, our assessment of the quality of the modelling indicates cost‐effectiveness analyses failed to comply with standards of reporting for economic evaluations and the assessment of relevance highlighted that both key parameters and scenarios are now outdated. Current evidence gaps include modelling to inform service development using updated programmatic information and ex post modelling to evaluate and inform efficient deployment of resources in support of PrEP, especially among key populations, using direct evidence of cost, adherence and uptake patterns. Conclusions Updated modelling which more appropriately captures PrEP programme delivery, uses current intervention scenarios, and is parameterized with data from demonstration and implementation projects is needed in support of more conclusive findings and actionable recommendations for programmes and policy. Future analyses should address these issues, aligning with countries to support the needs of programme planners and decision makers for models to more directly inform programme planning and policy.

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Section: Resultsmentioning

confidence: 99%

The impact, cost and cost‐effectiveness of oral pre‐exposure prophylaxis in sub‐Saharan Africa: a scoping review of modelling contributions and way forward

2019

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“…This cost data was collected in 2003 and published in 2006. While the importance of the paper as one of very few sources of ART cost data in the early years of the public-sector ART programme cannot be overstated, it was still used as a cost source for papers published as recently as 2016 [47–49]- at which stage the data used in the models was over 10 years old.…”

Section: Discussionmentioning

confidence: 99%

The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case

et al. 2019

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Background In economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Few analyses however use locally relevant cost data. We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country’s HIV programme. Methods We systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. Where no data was found in the literature, we constructed unit costs either based on available information regarding ingredients and relevant public-sector prices, or based on expenditure records. Results Only 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. Other papers detailed the costs of HCT, MMC, palliative and inpatient care; no papers were found on the costs of PrEP, social and behaviour change communication, and PMTCT. The results informed unit costs for 5 of 11 intervention categories included in the Investment Case, with the remainder costed based on ingredients (35%) and expenditure data (10%). Conclusions A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. More primary cost analyses of non-ART interventions are needed.

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“…Studies from different parts of the world showed that PrEP, especially when used concomitantly with other interventions, was highly effective in reducing new HIV diagnoses and in fact achieved the most rapid decrease (15)(16)(17)(18).…”

Section: Clinical and Research Consequencesmentioning

confidence: 99%

HIV Pre-Exposure Prophylaxis in Central and Eastern Europe-Gains and Challenges in An Ever-Changing World

Gökengin

2022

Infect Dis Clin Microbiol

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Pre-exposure prophylaxis (PrEP) is an effective prevention tool for controlling the HIV epidemic. Since its approval in the United States in 2012 and Europe in 2016, it has become available on a global scale offered as a registered strategy in clinical studies or demonstration projects with a slow and steady increase. In the second quarter of 2022, PrEP became available in 78 countries globally, with around 3 million people having started using PrEP. Europe has been much slower than the rest of the world to roll out PrEP; nevertheless, currently, PrEP is nationally available and reimbursed in 21 countries; generics are available but not reimbursed in 14 countries. PrEP is not formally implemented in 20 countries, which are mostly Central and Eastern European countries. There are significant disparities between countries in terms of PrEP availability, accessibility, and usage, most likely due to social, cultural, and political differences. The major barriers to PrEP use are reported to be lack of knowledge of people in need, not being reimbursed, and low perception of HIV. PrEP uptake globally and regionally still lacks the power to have an impact on controlling the epidemic. High prioritization of PrEP targets will offer us a realistic chance of reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal of a 90% reduction in HIV infections by 2030 compared to 2010. Keywords: pre-exposure prophylaxis, Central Europe, Eastern Europe, HIV infection, prevention

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Maximizing the benefits of ART and PrEP in resource-limited settings

Cited by 16 publications

References 28 publications

The impact, cost and cost‐effectiveness of oral pre‐exposure prophylaxis in sub‐Saharan Africa: a scoping review of modelling contributions and way forward

The impact, cost and cost‐effectiveness of oral pre‐exposure prophylaxis in sub‐Saharan Africa: a scoping review of modelling contributions and way forward

The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case

HIV Pre-Exposure Prophylaxis in Central and Eastern Europe-Gains and Challenges in An Ever-Changing World

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