In what circumstances could non-daily pre-exposure prophylaxis for HIV substantially reduce program costs?
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objectives:
To review the main factors influencing the costs of nondaily oral pre-
exposure prophylaxis (PrEP) with tenofovir (
emtricitabine). To estimate the cost
reductions possible with nondaily PrEP compared with daily PrEP for different popula-
tions (MSM and heterosexual populations).
Design:
Systematic review and data triangulation.
Methods:
We estimated the required number of tablets/person/week for dosing regi-
mens used in the HPTN 067/ADAPT (daily/time-driven/event-driven) and IPERGAY (on-
demand) trials for different patterns of sexual intercourse. Using trial data, and
behavioural and cost data obtained through systematic literature reviews, we estimated
cost savings resulting from tablet reductions for nondaily versus daily oral PrEP,
assuming 100% adherence.
Results:
Among different populations being prioritized for PrEP, the median reported
number of days of sexual activity varied between 0 and 2days/week (0–1.5days/week
for MSM, 1–2days/week for heterosexual populations). With 100% adherence and two
or fewer sex-days/week, HPTN 067/ADAPT nondaily regimens reduced the number of
tablets/week by more than 40% compared with daily PrEP. PrEP program costs were
reduced the most in settings with high drug costs, for example, by 66–69% with event-
driven PrEP for French/US populations reporting on average one sex-day/week.
Conclusion:
Nondaily oral PrEP could lower costs substantially (
>
50%) compared with
daily PrEP, particularly in high-income countries. Adherence and efficacy data are
needed to determine cost-effectiveness.
To review the main factors influencing the costs of nondaily oral pre-
exposure prophylaxis (PrEP) with tenofovir (
emtricitabine). To estimate the cost
reductions possible with nondaily PrEP compared with daily PrEP for different popula-
tions (MSM and heterosexual populations).
Design:
Systematic review and data triangulation.
Methods:
We estimated the required number of tablets/person/week for dosing regi-
mens used in the HPTN 067/ADAPT (daily/time-driven/event-driven) and IPERGAY (on-
demand) trials for different patterns of sexual intercourse. Using trial data, and
behavioural and cost data obtained through systematic literature reviews, we estimated
cost savings resulting from tablet reductions for nondaily versus daily oral PrEP,
assuming 100% adherence.
Results:
Among different populations being prioritized for PrEP, the median reported
number of days of sexual activity varied between 0 and 2days/week (0–1.5days/week
for MSM, 1–2days/week for heterosexual populations). With 100% adherence and two
or fewer sex-days/week, HPTN 067/ADAPT nondaily regimens reduced the number of
tablets/week by more than 40% compared with daily PrEP. PrEP program costs were
reduced the most in settings with high drug costs, for example, by 66–69% with event-
driven PrEP for French/US populations reporting on average one sex-day/week.
Conclusion:
Nondaily oral PrEP could lower costs substantially (
>
50%) compared with
daily PrEP, particularly in high-income countries. Adherence and efficacy data are
needed to determine cost-effectiveness.
Date Issued
2018-03-27
Date Acceptance
2018-01-24
Citation
AIDS, 2018, 32 (6), pp.809-818
ISSN
0269-9370
Publisher
Lippincott, Williams & Wilkins
Start Page
809
End Page
818
Journal / Book Title
AIDS
Volume
32
Issue
6
Copyright Statement
Q 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the
terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and
share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and
share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Sponsor
National Institutes of Health
Grant Number
2UMIAI068617 Sub#0000800798
Subjects
Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
cost savings
oral medicine
preexposure prophylaxis
prevention of sexual transmission
sexual behaviour
tenofovir
UNITED-STATES
HIGH-RISK
MEN
SEX
INTERMITTENT
PREVENTION
PREP
ACCEPTABILITY
WOMEN
INFECTION
06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status
Published