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PrEP probably cost effective in middle-income countries, but too costly to slash HIV incidence
Gus Cairns, 2012-10-12 09:40:00
What is probably the most detailed and realistic modelling study so far done of the impact and cost-effectiveness of pre-exposure prophylaxis (PrEP) finds that it could be very cost-effective in terms of the price of an extra year of healthy life for an individual taking it.
However, its absolute cost is likely to restrict its use to only the highest-risk individuals in a population, and this may mean it may only make a minor impact on HIV incidence.
These, at least, are the effects forecast amongst men who have sex with men (MSM) and transgender women (TGs) in the capital of a middle-income country. The country in the model is Lima, Peru, and the reason it was chosen as the base for the model is because it featured the highest number of enrolments to the seminal iPrEx study of PrEP in MSM/TGs, the first of several studies to report significant efficacy (in the case of iPrEx it cut HIV infections by 44%, even though only 50% of trial participants took enough doses of PrEP for it to work).
The inputs for the model were derived both from the data produced by iPrEx and from the anthropological and social research into the MSM/TG communities of Lima and Peru conducted in advance of the actual study; the latter was crucial to iPrEx's success because it enabled appropriate targeting and recruitment.
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