ArticleProceedings of the National Academy of Sciences of the United States of America2012
Economics of antiretroviral treatment vs. circumcision for HIV prevention.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Critical evaluation of arguments opposing male circumcision: A systematic review.Journal of evidence-based medicine · 2019Pooled it
- Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low- and Middle-Income Countries: A Systematic Literature Review.Health economics · 2016Pooled it
- Trial
- Circumcised men's perceptions, understanding and experiences of voluntary medical male circumcision in KwaZulu-Natal, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2020Article
- Structural Design and Data Requirements for Simulation Modelling in HIV/AIDS: A Narrative Review.PharmacoEconomics · 2019Review
- Modelling the human immunodeficiency virus (HIV) epidemic: A review of the substance and role of models in South Africa.Southern African journal of HIV medicine · 2018Article
- Predictors of male circumcision incidence in a traditionally non-circumcising South African population-based cohort.PloS one · 2018Article
- Universal test, treat, and keep: improving ART retention is key in cost-effective HIV control in Uganda.BMC infectious diseases · 2017Article
- Designing an optimal HIV programme for South Africa: Does the optimal package change when diminishing returns are considered?BMC public health · 2017Article
- Article
- Article
- Safety Profile of PrePex Male Circumcision Device and Client Satisfaction With Adolescent Males Aged 13-17 Years in Zimbabwe.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- HIV Treatment and Prevention: A Simple Model to Determine Optimal Investment.Medical decision making : an international journal of the Society for Medical Decision Making · 2016Article
- Long-term financing needs for HIV control in sub-Saharan Africa in 2015-2050: a modelling study.BMJ open · 2016Article
- Article
- The Price of Prevention: Cost Effectiveness of Biomedical HIV Prevention Strategies in South Africa.Clinical research in HIV/AIDS · 2016Article
- Length of secondary schooling and risk of HIV infection in Botswana: evidence from a natural experiment.The Lancet. Global health · 2015Article
- Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa.Southern African journal of HIV medicine · 2015Article
- Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress.Global public health · 2015Article
- How much does it cost to improve access to voluntary medical male circumcision among high-risk, low-income communities in Uganda?PloS one · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 3 countries.
Funding
Abstract
The HIV Prevention Trials Network (HPTN) 052 study, which showed the effectiveness of antiretroviral treatment in reducing HIV transmission, has been hailed as a "game changer" in the fight against HIV, prompting calls for scaling up treatment as prevention (TasP). However, it is unclear how TasP can be financed, given flat-lining support for global HIV programs. We assess whether TasP is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision (MMC) and antiretroviral treatment (ART) at CD4 <350/μL. We develop a new mathematical model and apply it to South Africa, finding that high ART coverage combined with high MMC coverage provides approximately the same HIV incidence reduction as TasP, for $5 billion less over 2009-2020. MMC outperforms ART significantly in cost per infection averted ($1,096 vs. $6,790) and performs comparably in cost per death averted ($5,198 vs. $5,604). TasP is substantially less cost effective at $8,375 per infection and $7,739 per death averted. The prevention benefits of HIV treatment are largely reaped with high ART coverage. The most cost-effective HIV prevention strategy is to expand MMC coverage and then scale up ART, but the most cost-effective HIV-mortality reduction strategy is to scale up MMC and ART jointly. TasP is cost effective by commonly used absolute benchmarks but it is far less cost effective than MMC and ART. Given South Africa's current annual ART spending, the $5 billion in savings offered by MMC and ART over TasP in the next decade, for similar health benefits, challenges the widely hailed status of TasP as a game changer.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.