TY - JOUR
T1 - Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria
AU - Mitchell, Kate M.
AU - Lépine, Aurélia
AU - Terris-Prestholt, Fern
AU - Torpey, Kwasi
AU - Khamofu, Hadiza
AU - Folayan, Morenike O.
AU - Musa, Jonah
AU - Anenih, James
AU - Sagay, Atiene S.
AU - Alhassan, Emmanuel
AU - Idoko, John
AU - Vickerman, Peter
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/9/24
Y1 - 2015/9/24
N2 - Objective: To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria. Design: Mathematical and cost modelling. Methods: A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4+ <350cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4+ <350cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective. Results: Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US $1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US $7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone. Conclusions: The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP.
AB - Objective: To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria. Design: Mathematical and cost modelling. Methods: A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4+ <350cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4+ <350cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective. Results: Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US $1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US $7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone. Conclusions: The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP.
KW - antiretroviral therapy
KW - condom
KW - disability-adjusted life years
KW - mathematical models
KW - pre-exposure prophylaxis
KW - treatment as prevention
UR - http://www.scopus.com/inward/record.url?scp=84965082032&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000000798
DO - 10.1097/QAD.0000000000000798
M3 - Article
C2 - 26355574
AN - SCOPUS:84965082032
SN - 0269-9370
VL - 29
SP - 2035
EP - 2044
JO - AIDS
JF - AIDS
IS - 15
ER -