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14-03-2013 | Psychology | Article

Targeted HIV prophylaxis key to cost effectiveness

Abstract

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medwireNews: A review of modeling studies shows that HIV pre-exposure prophylaxis (PrEP) is a cost-effective prevention strategy in many settings.

The analysis, which looked at epidemic populations in the USA, southern Africa, Eastern Europe, and Peru, showed that cost effectiveness tended to improve when participation was increased among people at high risk for HIV infection.

However, the researchers warn that implementing such targeted strategies is riddled with challenges, including the need to identify and engage with those at risk.

"In contexts where universal access to [antiretroviral therapy] for patients in need has not been achieved, PrEP programme planning processes will be challenged by concerns about social justice, equity, and affordability," write Gabriela Gomez (University of Amsterdam, the Netherlands) and colleagues in PLOS Medicine.

"This is in addition to the hurdles of overcoming the marginalisation, stigmatisation, and criminalisation of many of the populations that would most benefit from tailored HIV prevention programming that includes the choice of PreP."

The analysis included 13 modeling studies published since 2007 that assessed the cost effectiveness of PrEP scale-up in the following settings: heterosexual transmission in sub-Saharan Africa, among people who inject drugs (PWID) in Ukraine, and men who have sex with men (MSM) in the USA and Peru.

PrEP appeared cost effective in several settings, for example, benefits from the use of oral PrEP in South Africa were particularly pronounced when participants were prioritized by risk. Results in MSM in the USA were mixed , due to the high cost of antiretroviral drugs in some studies, while in Peru cost effectiveness was deemed plausible only when drugs were priced significantly lower than in the USA. However, PrEP among PWID in Ukraine was not deemed cost effective, particularly when compared with methadone maintenance therapy.

Gomez and colleagues say that their review should help decision makers to judge the relevance of cost-effectiveness estimates of PrEP programs, but that further research is needed.

"Given that our review shows that both the setting and which population is prioritised for [PrEP] are critical drivers of cost-effectiveness, the next step is to conduct context-specific demonstration studies, including comprehensive cost analyses, of different prioritisation and adherence promotion strategies to ensure that the maximum benefit from the introduction of [PrEP] is realised within combination HIV prevention programmes," they conclude.

By Kirsty Oswald, medwireNews Reporter

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