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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cost-effectiveness of tenofovir gel in urban South Africa: Model projections of HIV impact and threshold product prices
BMC Infectious Diseases, Volume 14, No. 1, Article 14, Year 2014
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Description
Background: There is urgent need for effective HIV prevention methods that women can initiate. The CAPRISA 004 trial showed that a tenofovir-based vaginal microbicide had significant impact on HIV incidence among women. This study uses the trial findings to estimate the population-level impact of the gel on HIV and HSV-2 transmission, and price thresholds at which widespread product introduction would be as cost-effective as male circumcision in urban South Africa.Methods: The estimated 'per sex-act' HIV and HSV-2 efficacies were imputed from CAPRISA 004. A dynamic HIV/STI transmission model, parameterised and fitted to Gauteng (HIV prevalence of 16.9% in 2008), South Africa, was used to estimate the impact of gel use over 15 years. Uptake was assumed to increase linearly to 30% over 10 years, with gel use in 72% of sex-acts. Full economic programme and averted HIV treatment costs were modelled. Cost per DALY averted is estimated and a microbicide price that equalises its cost-effectiveness to that of male circumcision is estimated.Results: Using plausible assumptions about product introduction, we predict that tenofovir gel use could lead to a 12.5% and 4.9% reduction in HIV and HSV-2 incidence respectively, by year 15. Microbicide introduction is predicted to be highly cost-effective (under $300 per DALY averted), though the dose price would need to be just $0.12 to be equally cost-effective as male circumcision. A single dose or highly effective (83% HIV efficacy per sex-act) regimen would allow for more realistic threshold prices ($0.25 and $0.33 per dose, respectively).Conclusions: These findings show that an effective coitally-dependent microbicide could reduce HIV incidence by 12.5% in this setting, if current condom use is maintained. For microbicides to be in the range of the most cost-effective HIV prevention interventions, product costs will need to decrease substantially. © 2014 Terris-Prestholt et al.; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3899035/bin/1471-2334-14-14-S1.docx
Authors & Co-Authors
Terris-Prestholt, Fern
Unknown Affiliation
Foss, Anna M.
Unknown Affiliation
Cox, Andrew P.
Unknown Affiliation
Heise, Lori
Unknown Affiliation
Meyer-Rath, Gesine
Unknown Affiliation
Delany-Moretlwe, Sinead
Unknown Affiliation
Mertenskoetter, Thomas
Unknown Affiliation
Rees, Helen V.
Unknown Affiliation
Vickerman, Peter T.
Unknown Affiliation
Watts, Charlotte H.
Unknown Affiliation
Statistics
Citations: 25
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1186/1471-2334-14-14
e-ISSN:
14712334
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa
Participants Gender
Male
Female