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Using a deterministic, compartmental model for HIV transmission, we estimated the incremental impact after five years of using pre-exposure prophylaxis (PrEP) among the adult population in 42 Subsaharan African countries.
We assumed an efficacy of 68%, adherence of 80%; coverage the same as currently for ART, and annual cost of PrEP of $150 per person. After five years, PrEP averted more than 950,000 HIV infections; 25% in South Africa. Average Incremental cost-effectiveness would be 8,051 US$/DALY and ranges from 831 US$/DALYs in Lesotho to 92,678 US$/DALY in Eritrea. PrEP will have its maximum impact and be most cost-effective where HIV prevalence is high and male circumcision is low, but combined with multiple strategies to control the HIV pandemic.
Pre-Exposure Prophylaxis for HIV in 42 Subsaharan countries is remarkably cost effective where HIV transmission is highest and male circumcision is lowest when compliance and adherence to the regimen is at least 80%.
Where HIV transmission is high and male circumcision is low, then Pre-Exposure Prophylaxis can cost-effectively avert substantial new HIV infections, however this requires compliance with this treatment regimen to average 80%.
submitted for publication Feb 2012