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

doi:10.1097/QAD.0000000000000798

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

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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 language	English
Pages (from-to)	2035-2044
Number of pages	10
Journal	AIDS
Volume	29
Issue number	15
DOIs	https://doi.org/10.1097/QAD.0000000000000798
Publication status	Published - 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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@article{1694862205034184b6b43acb11f883cd,

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

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.",

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",

author = "Mitchell, {Kate M} and Aur{\'e}lia L{\'e}pine and Fern Terris-Prestholt and Kwasi Torpey and Hadiza Khamofu and Folayan, {Morenike O} and Jonah Musa and James Anenih and Sagay, {Atiene S} and Emmanuel Alhassan and John Idoko and Peter Vickerman",

year = "2015",

month = sep,

day = "24",

doi = "10.1097/QAD.0000000000000798",

language = "English",

volume = "29",

pages = "2035--2044",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams and Wilkins",

number = "15",

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TY - JOUR

T1 - Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria

AU - Mitchell, Kate M

AU - Lépine, Aurélia

AU - Terris-Prestholt, Fern

AU - Torpey, Kwasi

AU - Khamofu, Hadiza

AU - Folayan, Morenike O

AU - Musa, Jonah

AU - Anenih, James

AU - Sagay, Atiene S

AU - Alhassan, Emmanuel

AU - Idoko, John

AU - Vickerman, Peter

PY - 2015/9/24

Y1 - 2015/9/24

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Anti-Retroviral Agents

KW - Chemoprevention

KW - Cohort Studies

KW - Condoms

KW - Cost-Benefit Analysis

KW - Disease Transmission, Infectious

KW - Female

KW - HIV Infections

KW - HIV Seronegativity

KW - HIV Seropositivity

KW - Humans

KW - Male

KW - Middle Aged

KW - Models, Theoretical

KW - Nigeria

KW - Pre-Exposure Prophylaxis

KW - Sexual Partners

KW - Young Adult

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568890/

U2 - 10.1097/QAD.0000000000000798

DO - 10.1097/QAD.0000000000000798

M3 - Article (Academic Journal)

C2 - 26355574

VL - 29

SP - 2035

EP - 2044

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 15

ER -

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

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