Estimating the Cost-Effectiveness of Pre-Exposure Prophylaxis to Reduce HIV-1 and HSV-2 Incidence in HIV-Serodiscordant Couples in South Africa

• DOI: 10.1371/journal.pone.0115511
• Publication Date: 2015-01-23T23:40:39Z
• Authors: Britta L. Jewell; Ide Cremin; Michael Pickles; Connie Celum; Jared M. Baeten; Sinead Delany-Mor...; Timothy B. Hallett
• Keywords: Male; TRANSMISSION; General Science & Technology; Anti-HIV Agents; Science; Cost-Benefit Analysis; Organophosphonates; 610; MALE CIRCUMCISION; Couples Therapy; South Africa; 03 medical and health sciences; 0302 clinical medicine; ANTIRETROVIRAL THERAPY; HIV Seroprevalence; 616; INFECTION; MD Multidisciplinary; HIV Seropositivity; Humans; DISCORDANT COUPLES; Tenofovir; Family Characteristics; Science & Technology; Adenine; Q; R; GENITAL HERPES; RANDOMIZED CONTROLLED-TRIAL; HIV-1-DISCORDANT COUPLES; PREVENTION; 3. Good health; Multidisciplinary Sciences; SIMPLEX-VIRUS TYPE-2; HIV-2; HIV-1; Science & Technology - Other Topics; Medicine; Female; Pre-Exposure Prophylaxis; Research Article

To estimate the cost-effectiveness of daily oral tenofovir-based PrEP, with a protective effect against HSV-2 as well as HIV-1, among HIV-1 serodiscordant couples in South Africa.We incorporated HSV-2 acquisition, transmission, and interaction with HIV-1 into a microsimulation model of heterosexual HIV-1 serodiscordant couples in South Africa, with use of PrEP for the HIV-1 uninfected partner prior to ART initiation for the HIV-1 1infected partner, and for one year thereafter.We estimate the cost per disability-adjusted life-year (DALY) averted for two scenarios, one in which PrEP has no effect on reducing HSV-2 acquisition, and one in which there is a 33% reduction. After a twenty-year intervention, the cost per DALY averted is estimated to be $10,383 and $9,757, respectively--a 6% reduction, given the additional benefit of reduced HSV-2 acquisition. If all couples are discordant for both HIV-1 and HSV-2, the cost per DALY averted falls to $1,445, which shows that the impact is limited by HSV-2 concordance in couples.After a 20-year PrEP intervention, the cost per DALY averted with a reduction in HSV-2 is estimated to be modestly lower than without any effect, providing an increase of health benefits in addition to HIV-1 prevention at no extra cost. The small degree of the effect is in part due to a high prevalence of HSV-2 infection in HIV-1 serodiscordant couples in South Africa.