October 11, 2012
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PrEP cost-effective among MSM, but requires significant expenditures

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Pre-exposure prophylaxis among men who have sex with men and transwomen appeared cost-effective, but would require significant expenditures to reduce incidence of HIV, according to recent data.

“Although it could have been expected that pre-exposure prophylaxis (PrEP) was not relevant to middle-income settings due to its high cost, we have shown that it actually would be cost-effective under certain scenarios and, therefore, should be considered one of the tools to be used in combination prevention,” Annick Borquez, a PhD student in the department of infectious disease epidemiology, School of Public Health, Imperial College London, told Infectious Disease News. “However, it will not be affordable at a large scale.”

Annick Borquez

Annick Borquez

Borquez and colleagues analyzed the cost-effectiveness, impact and cost of PrEP by developing a mathematical model of the HIV epidemic among MSM and transwomen in Lima, Peru. They estimated the cost of providing PrEP to patients by using CDC guidelines.

In the low-coverage scenario that assumes a 5% coverage rate, 8% of HIV infections could be prevented if the program prioritizes those at higher risk, and the adherence level is similar to that found in the iPrEx trial. However, the cost per disability-adjusted life year averted is below the WHO-CHOICE threshold for a cost-effective intervention, except for scenarios with low coverage and prioritization programs. The researchers also found that when those on PrEP decrease condom use, the effect of PrEP also reduces.

“PrEP can be an additional prevention tool for vulnerable populations such as MSM who have frequent exposures and/or transgender women involved in sex work who are not always able to negotiate condom use successfully,” Borquez said. “On the other hand, it is still an expensive alternative with important monitoring requirements, such as the need for a surveillance system of emergence of resistance, and behavioral changes that might increase the risk of STD spread if decreases in condom use follow uptake of PrEP.”

Borquez said future research should evaluate how to place PrEP within programs exploring the new strategic use of ART.

Disclosure: Borquez reports no relevant financial disclosures.