Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria.


Mitchell, KM; Lepine, A; Terris-Prestholt, F; Torpey, K; Khamofu, H; Folayan, MO; Musa, J; Anenih, J; Sagay, AS; Alhassan, E; Idoko, J; Vickerman, P; (2015) Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria. AIDS (London, England), 29 (15). pp. 2035-44. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0000000000000798

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Abstract

To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria. Mathematical and cost modelling. 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 <350 cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4 <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective. 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. 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.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Centre for the Mathematical Modelling of Infectious Diseases
SaME Modelling & Economics
Social and Mathematical Epidemiology (SaME)
PubMed ID: 26355574
Web of Science ID: 368495900001
URI: http://researchonline.lshtm.ac.uk/id/eprint/2534591

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