@article{fdi:010053135,
  title = {{E}valuating the cost-effectiveness of pre-exposure prophylaxis ({P}r{EP}) and its impact on {HIV}-1 transmission in {S}outh {A}frica},
  author = {{P}retorius, {C}. and {S}tover, {J}. and {B}ollinger, {L}. and {B}aca{\¨e}r, {N}icolas and {W}illiams, {B}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {M}athematical modelers have given little attention to the question of how pre-exposure prophylaxis ({P}r{EP}) may impact on a generalized national {HIV} epidemic and its cost-effectiveness, in the context of control strategies such as condom use promotion and expanding {ART} programs. {M}ethodology/{P}rincipal {F}indings: {W}e use an age-and gender-structured model of the generalized {HIV} epidemic in {S}outh {A}frica to investigate the potential impact of {P}r{EP} in averting new infections. {T}he model utilizes age-structured mortality, fertility, partnership and condom use data to model the spread of {HIV} and the shift of peak prevalence to older age groups. {T}he model shows that universal {P}r{EP} coverage would have to be impractically high to have a significant effect on incidence reduction while {ART} coverage expands. {P}r{EP} targeted to 15-35-year-old women would avert 10%-25% (resp. 13%-28%) of infections in this group and 5%-12% (resp. 7%-16%) of all infections in the period 2014-2025 if baseline incidence is 0.5% per year at 2025 (resp. 0.8% per year at 2025). {T}he cost would be $12,500-$20,000 per infection averted, depending on the level of {ART} coverage and baseline incidence. {A}n optimistic scenario of 30%-60% {P}r{EP} coverage, efficacy of at least 90%, no behavior change among {P}r{EP} users and {ART} coverage less than three times its 2010 levels is required to achieve this result. {T}argeting {P}r{EP} to 25-35-year-old women (at highest risk of infection) improves impact and cost-effectiveness marginally. {R}elatively low levels of condom substitution (e. g., 30%) do not nullify the efficacy of {P}r{EP}, but reduces cost-effectiveness by 35%-40%. {C}onclusions/{S}ignificance: {P}r{EP} can avert as many as 30% of new infections in targeted age groups of women at highest risk of infection. {T}he cost-effectiveness of {P}r{EP} relative to {ART} decreases rapidly as {ART} coverage increases beyond three times its coverage in 2010, after which the {ART} program would provide coverage to more than 65% of {HIV}+ individuals. {T}o have a high relative cost-effective impact on reducing infections in generalized epidemics, {P}r{EP} must utilize a window of opportunity until {ART} has been scaled up beyond this level.},
  keywords = {},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {5},
  numero = {11},
  pages = {e13646},
  ISSN = {1932-6203},
  year = {2010},
  DOI = {10.1371/journal.pone.0013646},
  URL = {https://www.documentation.ird.fr/hor/fdi:010053135},
}