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Potential cost-effectiveness of community availability of tenofovir, lamivudine, and dolutegravir for HIV prevention and treatment in east, central, southern, and west Africa: a modelling analysis

2023; Elsevier BV; Volume: 11; Issue: 10 Linguagem: Inglês

10.1016/s2214-109x(23)00383-2

2572-116X

Andrew Phillips, Loveleen Bansi‐Matharu, Maryam Shahmanesh, James Hargreaves, Jennifer Smith, Paul Revill, Euphemia Sibanda, Peter Ehrenkranz, Kenly Sikwese, Alison Rodger, Jens Lundgren, Charles F. Gilks, Catherine Godfrey, Frances M. Cowan, Valentina Cambiano,

HIV, Drug Use, Sexual Risk

Background Post-exposure prophylaxis (PEP) offers protection from HIV after condomless sex, but is not widely available in a timely manner in east, central, southern, and west Africa.To inform the potential pilot implementation of such an approach, we modelled the effect and cost-effectiveness of making PEP consisting of tenofovir, lamivudine, and dolutegravir (TLD) freely and locally available in communities without prescription, with the aim of enabling PEP use within 24 h of condomless sex.Free community availability of TLD (referred to as community TLD) might also result in some use of TLD as pre-exposure prophylaxis (PrEP) and as antiretroviral therapy for people living with HIV.Methods Using an existing individual-based model (HIV Synthesis), we explicitly modelled the potential positive and negative effects of community TLD.Through the sampling of parameter values we created 1000 setting-scenarios, reflecting the uncertainty in assumptions and a range of settings similar to those seen in east, central, southern, and west Africa (with a median HIV prevalence of 14•8% in women and 8•1% in men).For each setting scenario, we considered the effects of community TLD.TLD PEP was assumed to have at least 90% efficacy in preventing HIV infection after condomless sex with a person living with HIV. FindingsThe modelled effects of community TLD availability based on an assumed high uptake of TLD resulted in a mean reduction in incidence of 31% (90% range over setting scenarios, 6% increase to 57% decrease) over 20 years, with an HIV incidence reduction over 50 years in 91% of the 1000 setting scenarios, deaths averted in 55% of scenarios, reduction in costs in 92% of scenarios, and disability-adjusted life-years averted in 64% of scenarios with community TLD.Community TLD was cost-effective in 90% of setting scenarios and cost-saving (with disabilityadjusted life-years averted) in 58% of scenarios.When only examining setting scenarios in which there was lower uptake of community TLD, community TLD is cost-effective in 92% of setting scenarios.Interpretation The introduction of community TLD, enabling greater PEP access, is a promising approach to consider further in pilot implementation projects.