Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria

Kate M Mitchell, Aurélia Lépine, Fern Terris-Prestholt, Kwasi Torpey, Hadiza Khamofu, Morenike O Folayan, Jonah Musa, James Anenih, Atiene S Sagay, Emmanuel Alhassan, John Idoko, Peter Vickerman

Research output: Contribution to journalArticle (Academic Journal)peer-review

27 Citations (Scopus)
354 Downloads (Pure)

Abstract

OBJECTIVE: To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria.

DESIGN: Mathematical and cost modelling.

METHODS: A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4 <350 cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4 <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective.

RESULTS: Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US $1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US $7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone.

CONCLUSIONS: The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP.

Original languageEnglish
Pages (from-to)2035-2044
Number of pages10
JournalAIDS
Volume29
Issue number15
DOIs
Publication statusPublished - 24 Sep 2015

Keywords

  • Adolescent
  • Adult
  • Anti-Retroviral Agents
  • Chemoprevention
  • Cohort Studies
  • Condoms
  • Cost-Benefit Analysis
  • Disease Transmission, Infectious
  • Female
  • HIV Infections
  • HIV Seronegativity
  • HIV Seropositivity
  • Humans
  • Male
  • Middle Aged
  • Models, Theoretical
  • Nigeria
  • Pre-Exposure Prophylaxis
  • Sexual Partners
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't

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