考虑耐药性因素的夸祖鲁-纳塔尔省无保护性行为集中性暴露前预防的潜在影响和成本效益。
Potential Impact and Cost-Effectiveness of Condomless-Sex-Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance.
机构信息
Institute for Global Health, University College London, London, UK.
Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
出版信息
J Infect Dis. 2021 Apr 23;223(8):1345-1355. doi: 10.1093/infdis/jiz667.
INTRODUCTION
Oral preexposure prophylaxis (PrEP) in the form of tenofovir-disoproxil-fumarate/emtricitabine is being implemented in selected sites in South Africa. Addressing outstanding questions on PrEP cost-effectiveness can inform further implementation.
METHODS
We calibrated an individual-based model to KwaZulu-Natal to predict the impact and cost-effectiveness of PrEP, with use concentrated in periods of condomless sex, accounting for effects on drug resistance. We consider (1) PrEP availability for adolescent girls and young women aged 15-24 years and female sex workers, and (2) availability for everyone aged 15-64 years. Our primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programs.
RESULTS
In the context of PrEP use in adults aged 15-64 years, there was a predicted 33% reduction in incidence and 36% reduction in women aged 15-24 years. PrEP was cost-effective, including in a range of sensitivity analyses, although with substantially reduced (cost) effectiveness under a policy of ART initiation with efavirenz- rather than dolutegravir-based regimens due to PrEP undermining ART effectiveness by increasing HIV drug resistance.
CONCLUSIONS
PrEP use concentrated during time periods of condomless sex has the potential to substantively impact HIV incidence and be cost-effective.
引言
以富马酸替诺福韦二吡呋酯/恩曲他滨片为形式的口服暴露前预防（PrEP）正在南非的一些指定地点实施。解决 PrEP 成本效益方面的悬而未决的问题可以为进一步实施提供信息。
方法
我们校准了夸祖鲁-纳塔尔省的基于个体的模型，以预测 PrEP 的影响和成本效益，将使用集中在无保护性行为期间，同时考虑药物耐药性的影响。我们考虑了以下两种情况：（1）为 15-24 岁的少女和年轻女性以及女性性工作者提供 PrEP，（2）为 15-64 岁的所有人提供 PrEP。我们的主要分析代表了未来 PrEP 计划预计可以实现的 PrEP 使用水平。
结果
在 15-64 岁成年人中使用 PrEP 的情况下，15-24 岁女性的发病率预计会降低 33%，女性的发病率预计会降低 36%。PrEP 在成本效益方面具有优势，包括在一系列敏感性分析中，但由于 PrEP 通过增加 HIV 药物耐药性来削弱 ART 的有效性，导致基于依非韦伦而不是多替拉韦的方案启动 ART 的政策下，（成本）效益大大降低。
结论
在无保护性行为期间集中使用 PrEP 有可能实质性地影响 HIV 发病率，并具有成本效益。
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