Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria. (24th September 2015)

• Record Type: Journal Article
• Authors: Mitchell, Kate M.; Lépine, Aurélia; Terris-Prestholt, Fern; Torpey, Kwasi; Khamofu, Hadiza; Folayan, Morenike O.; Musa, Jonah; Anenih, James; Sagay, Atiene S.; Alhassan, Emmanuel; Idoko, John; Vickerman, Peter
• Is Part Of: AIDS. Volume 29:Number 15(2015)
• Publication Date: 2015-09-24
• Subjects: AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000000798
• Languages: English
• ISSNs: 0269-9370

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria.</p> </sec> <sec> <title>Design:</title> <p>Mathematical and cost modelling.</p> </sec> <sec> <title>Methods:</title> <p>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<sup>+</sup> <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<sup>+</sup> <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective.</p> </sec> <sec> <title>Results:</title> <p>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.</p> </sec> <sec> <title>Conclusions:</title> <p>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.</p> </sec> </abstract>