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: Serodiscordant; Pre-exposure prophylaxis; Concordance

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