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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Optimal uses of antiretrovirals for prevention in HIV-1 serodiscordant heterosexual couples in South Africa: A modelling study
PLoS Medicine, Volume 8, No. 11, Article e1001123, Year 2011
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Description
Background: Antiretrovirals have substantial promise for HIV-1 prevention, either as antiretroviral treatment (ART) for HIV-1-infected persons to reduce infectiousness, or as pre-exposure prophylaxis (PrEP) for HIV-1-uninfected persons to reduce the possibility of infection with HIV-1. HIV-1 serodiscordant couples in long-term partnerships (one member is infected and the other is uninfected) are a priority for prevention interventions. Earlier ART and PrEP might both reduce HIV-1 transmission in this group, but the merits and synergies of these different approaches have not been analyzed. Methods and Findings: We constructed a mathematical model to examine the impact and cost-effectiveness of different strategies, including earlier initiation of ART and/or PrEP, for HIV-1 prevention for serodiscordant couples. Although the cost of PrEP is high, the cost per infection averted is significantly offset by future savings in lifelong treatment, especially among couples with multiple partners, low condom use, and a high risk of transmission. In some situations, highly effective PrEP could be cost-saving overall. To keep couples alive and without a new infection, providing PrEP to the uninfected partner could be at least as cost-effective as initiating ART earlier in the infected partner, if the annual cost of PrEP is <40% of the annual cost of ART and PrEP is >70% effective. Conclusions: Strategic use of PrEP and ART could substantially and cost-effectively reduce HIV-1 transmission in HIV-1 serodiscordant couples. New and forthcoming data on the efficacy of PrEP, the cost of delivery of ART and PrEP, and couples behaviours and preferences will be critical for optimizing the use of antiretrovirals for HIV-1 prevention. © 2011 Hallett et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s001.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s002.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s003.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s004.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s005.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s006.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3217021/bin/pmed.1001123.s007.pdf
Authors & Co-Authors
Hallett, Timothy B.
United Kingdom, London
Imperial College London
Baeten, Jared M.
United States, Seattle
University of Washington
Heffron, Renee A.
United States, Seattle
University of Washington
Barnabas, Ruanne Vanessa
United States, Seattle
University of Washington
De Bruyn, Guy
South Africa, Johannesburg
University of the Witwatersrand
Cremin, Íde
United Kingdom, London
Imperial College London
Delany-Moretlwe, Sinead
South Africa, Johannesburg
University of the Witwatersrand
Garnett, Geoff Peter
United Kingdom, London
Imperial College London
Gray, Glenda E.
South Africa, Johannesburg
University of the Witwatersrand
Johnson, Leigh Francis
South Africa, Cape Town
University of Cape Town
McIntyre, James Alasdair
South Africa, Johannesburg
University of the Witwatersrand
Rees, Helen V.
South Africa, Johannesburg
University of the Witwatersrand
Celum, Connie L.
United States, Seattle
University of Washington
Statistics
Citations: 158
Authors: 13
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pmed.1001123
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Infectious Diseases
Study Locations
South Africa