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cost effectiveness of pre exposure prophylaxis

Iryna Zablotska, Andrew E Grulich, Nittaya Phanuphak, Tarandeep Anand, Surang Janyam, Midnight Poonkasetwattana, Rachel Baggaley, Frits van Griensven, Ying-Ru Lo
INTRODUCTION: HIV epidemics in the Asia-Pacific region are concentrated among men who have sex with men (MSM) and other key populations. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention and could be a potential game changer in the region. We discuss the progress towards PrEP implementation in the Asia-Pacific region, including opportunities and barriers. DISCUSSION: Awareness about PrEP in the Asia-Pacific is still low and so are its levels of use...
2016: Journal of the International AIDS Society
Giovanni Ravasi, Beatriz Grinsztejn, Ricardo Baruch, Juan Vicente Guanira, Ricardo Luque, Carlos F Cáceres, Massimo Ghidinelli
INTRODUCTION: Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool...
2016: Journal of the International AIDS Society
Carlos F Cáceres, Annick Borquez, Jeffrey D Klausner, Rachel Baggaley, Chris Beyrer
BACKGROUND: In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. DISCUSSION: The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives...
2016: Journal of the International AIDS Society
Jessica B McGillen, Sarah-Jane Anderson, Timothy B Hallett
INTRODUCTION: The new WHO guidelines recommend offering pre-exposure prophylaxis (PrEP) to people who are at substantial risk of HIV infection. However, where PrEP should be prioritised, and for which population groups, remains an open question. The HIV landscape in sub-Saharan Africa features limited prevention resources, multiple options for achieving cost saving, and epidemic heterogeneity. This paper examines what role PrEP should play in optimal prevention in this complex and dynamic landscape...
2016: Journal of the International AIDS Society
Sheena Mary McCormack, Veronica Noseda, Jean-Michel Molina
INTRODUCTION: In contrast to the global trend showing a decline in new HIV infections, the number reported in the World Health Organization (WHO) region of Europe is increasing. Health systems are disparate, but even countries with free access to screening and treatment observe continuing high rates of new infections in key populations, notably men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is only available in France. This commentary describes the European epidemics and healthcare settings where PrEP could be delivered, how need might be estimated for MSM and the residual barriers to access...
2016: Journal of the International AIDS Society
Derek D Satre, Andrea Altschuler, Sujaya Parthasarathy, Michael J Silverberg, Paul Volberding, Cynthia I Campbell
OBJECTIVES: This study examined implementation of the Affordable Care Act (ACA) in relation to HIV-positive patient enrollment in an integrated health care system; as well as changes in new enrollee characteristics, benefit structure and health care utilization after key ACA provisions went into effect in 2014. METHODS: This mixed-methods study was set in Kaiser Permanente Northern California (KPNC). Qualitative interviews with 29 KPNC leaders explored planning for ACA implementation...
October 3, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Janneke P Bil, Wendy M van der Veldt, Maria Prins, Ineke G Stolte, Udi Davidovich
Although PrEP is not yet registered in Europe, including the Netherlands, its approval and implementation are expected in the near future. To inform future pre-exposure prophylaxis (PrEP) implementation, this study aimed to gain insight into motives and preferences for daily or intermittent PrEP use among Dutch HIV-negative men having sex with men (MSM).Between February and December 2013, semistructured interviews were conducted until data saturation was reached (N = 20). Interviews were analyzed using the Grounded Theory approach...
September 2016: Medicine (Baltimore)
Gabriela B Gomez, Robyn Eakle, Judie Mbogua, Godspower Akpomiemie, W D Francois Venter, Helen Rees
INTRODUCTION: Updated guidelines from the WHO recommend antiretroviral treatment for adults with HIV at any CD4 count and daily oral pre-exposure prophylaxis (PrEP) for people at substantial risk of HIV infection. However, implementation challenges may hinder the ability of programmes to translate these recommendations into successful practice. This demonstration project is the first to integrate PrEP and immediate treatment (ITx) for female sex workers (FSWs) in South Africa to answer operational research questions...
2016: BMJ Open
Olubanke Davies, Andrew Ustianowski, Julie Fox
Pre-exposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. It is protective against HIV infection across populations and has few significant safety risks and little evidence of behavioural risk compensation. This article summarises the evidence behind HIV PrEP as an intervention, populations that may benefit, current guidelines and programmes, and the cost-effectiveness modelling of this strategy.
September 27, 2016: Infectious Diseases and Therapy
Brooke E Nichols, Charles A B Boucher, Marc van der Valk, Bart J A Rijnders, David A M C van de Vijver
BACKGROUND: Pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine prevents HIV infections among men who have sex with men (MSM). PrEP can be given on a daily or intermittent basis. Unfortunately, PrEP is not reimbursed in most European countries. Cost-effectiveness analyses of PrEP among MSM in Europe are absent but are key for decision makers to decide upon PrEP implementation. METHODS: We developed a deterministic mathematical model, calibrated to the well defined Dutch HIV epidemic among MSM, to predict the effect and cost-effectiveness of PrEP...
September 22, 2016: Lancet Infectious Diseases
Derek R MacFadden, Darrell H Tan, Sharmistha Mishra
INTRODUCTION: Once-daily tenofovir/emtricitabine-based pre-exposure prophylaxis (PrEP) can reduce HIV acquisition in men who have sex with men (MSM), by 44% in the iPrEx trial, and reaching up to 99% with high adherence. We examined the potential population-level impact and cost-effectiveness of different PrEP implementation strategies. METHODS: We developed a dynamic, stochastic compartmental model of HIV transmission among the estimated 57,400 MSM in Toronto, Canada...
2016: Journal of the International AIDS Society
Emmanuel F Drabo, Joel W Hay, Raffaele Vardavas, Zachary R Wagner, Neeraj Sood
BACKGROUND:  Substantial gaps remain in understanding the trade-offs between the costs and benefits of choosing alternative human immunodeficiency virus (HIV) prevention strategies, including test-and-treat (expanded HIV testing combined with immediate treatment) and PrEP (initiation of preexposure prophylaxis by high-risk uninfected individuals) strategies. METHODS:  We develop a mathematical epidemiological model to simulate HIV incidence among men residing in Los Angeles County, California, aged 15-65 years, who have sex with men...
August 23, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Jennifer A Smith, Sarah-Jane Anderson, Kate L Harris, Jessica B McGillen, Edward Lee, Geoff P Garnett, Timothy B Hallett
BACKGROUND: Many ways of preventing HIV infection have been proposed and more are being developed. We sought to construct a strategic approach to HIV prevention that would use limited resources to achieve the greatest possible prevention impact through the use of interventions available today and in the coming years. METHODS: We developed a deterministic compartmental model of heterosexual HIV transmission in South Africa and formed assumptions about the costs and effects of a range of interventions, encompassing the further scale-up of existing interventions (promoting condom use, male circumcision, early antiretroviral therapy [ART] initiation for all [including increased HIV testing and counselling activities], and oral pre-exposure prophylaxis [PrEP]), the introduction of new interventions in the medium term (offering intravaginal rings, long-acting injectable antiretroviral drugs) and long term (vaccine, broadly neutralising antibodies [bNAbs])...
July 2016: Lancet HIV
Joan T Price, Stephanie B Wheeler, Lynda Stranix-Chibanda, Sybil G Hosek, D Heather Watts, George K Siberry, Hans M L Spiegel, Jeffrey S Stringer, Benjamin H Chi
INTRODUCTION: Antiretroviral pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition is cost-effective when delivered to those at substantial risk. Despite a high incidence of HIV infection among pregnant and breastfeeding women in sub-Saharan Africa (SSA), a theoretical increased risk of preterm birth on PrEP could outweigh the HIV prevention benefit. METHODS: We developed a decision analytic model to evaluate a strategy of daily oral PrEP during pregnancy and breastfeeding in SSA...
August 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Amy Braksmajer, Theresa E Senn, James McMahon
HIV and intimate partner violence (IPV) are significant intersecting threats to women's health. Women in violent relationships have few feasible HIV risk reduction options as traditional prevention methods are largely dependent on a partner's cooperation. The purpose of this review is to explore potential benefits and drawbacks of pre-exposure prophylaxis (PrEP) use among women in the United States experiencing IPV. Advantages of PrEP use in this population include the potential for covert or autonomous use, coital independence, dual protection against sexual and injection risk, and facilitated connections to social services...
June 2016: AIDS Patient Care and STDs
Joana R S P Falcão, Catriona C Bradshaw, Cameryn C Garrett, Jade E Bilardi, Marcus Y Chen, Iryna Zablotska, Christopher K Fairley, Henrietta Williams
Background: Pre-exposure prophylaxis (PrEP) may be an effective option for HIV prevention among heterosexual serodiscordant couples. However, there are knowledge gaps in social research about PrEP in heterosexual serodiscordant relationships, including motivations and barriers to its use and possible impacts of PrEP uptake on the sexual practices of these couples. The aim of this study was to explore the views of HIV-negative men and women in stable serodiscordant heterosexual relationships about the possible use of PrEP...
May 26, 2016: Sexual Health
King T Cheung, Christopher K Fairley, Tim R H Read, Ian Denham, Glenda Fehler, Catriona S Bradshaw, Marcus Y Chen, Eric P F Chow
INTRODUCTION: The aim of this study was to determine the risk factors for HIV infection and the incidence in men who have sex with men (MSM). It is important to identify subgroups of MSM in which preventive interventions such as pre-exposure prophylaxis (PrEP) offered at the time of their last negative test would be considered cost-effective. METHODS: We conducted a retrospective cohort study of MSM attending Melbourne Sexual Health Centre (MSHC) during 2007-2013 with at least two HIV tests within 12 months of each other...
2016: PloS One
Irene Kuo, Halli Olsen, Rudy Patrick, Gregory Phillips, Manya Magnus, Jenevieve Opoku, Anthony Rawls, James Peterson, Flora Hamilton, Michael Kharfen, Alan Greenberg
INTRODUCTION: Use of pre-exposure prophylaxis (PrEP) among people who inject drugs (PWID) has been shown to be effective in preventing HIV transmission. We examined correlates of the willingness to use PrEP among community-recruited older PWID in Washington, DC. METHODS: PWID were recruited using respondent-driven sampling (RDS) and completed a behavioral interview for the National HIV Behavioral Surveillance system in 2012. Participants reported on willingness to use PrEP and how it might affect their drug use and sexual behaviors...
July 1, 2016: Drug and Alcohol Dependence
Virginia A Fonner, Sarah L Dalglish, Caitlin E Kennedy, Rachel Baggaley, Kevin R O'Reilly, Florence M Koechlin, Michelle Rodolph, Ioannis Hodges-Mameletzis, Robert M Grant
OBJECTIVE: Preexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes. DESIGN: Rigorous systematic review and meta-analysis...
July 31, 2016: AIDS
Venessa M J Ryan, Joanne M Langley, Linda Dodds, Pantelis Andreou
BACKGROUND: Prophylaxis against respiratory syncytial virus-associated hospitalization (RSV-H) with anti-RSV monoclonal antibody is not considered cost-effective for routine use in most jurisdictions. The aim of this study was to develop a scoring tool to estimate local risk of RSV-H in the first year of life among moderately premature infants to assist in prophylaxis decision making. METHODS: A retrospective cohort was constructed from population-based databases in Nova Scotia, Canada, to follow 32- to 35-week gestation infants from the prenatal period to <12 months of age, from 1998 to 2008...
August 2016: Pediatric Infectious Disease Journal
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