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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; ... Vickerman, P; + view all (2015) Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria. AIDS , 29 (15) pp. 2035-2044. 10.1097/QAD.0000000000000798. Green open access

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Abstract

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+ <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. / 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.

Type: Article
Title: Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000000798
Publisher version: https://doi.org/10.1097/QAD.0000000000000798
Language: English
Additional information: This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (http://creativecommons.org/licenses/by-nc-nd/4.0), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
Keywords: antiretroviral therapy, condom, disability-adjusted life years, mathematical models, pre-exposure prophylaxis, treatment as prevention
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10070167
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