ArticleJournal of the International AIDS Society2018
The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil.
Article in Journal of the International AIDS Society, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Evolving landscape of economic evaluations of HIV pre-exposure prophylaxis and pre-exposure prophylaxis implementation strategies: a systematic review.Journal of the International AIDS Society · 2025Pooled it
- Cost-Effectiveness of an Interdisciplinary, Internet-Based Transgender Health Care Program in Germany: Economic Evaluation Alongside a Randomized Controlled Trial.Journal of medical Internet research · 2025Trial
- Long-Acting PrEP for People With High Vulnerability to HIV Acquisition in Brazil: A Cost-Effectiveness Analysis.Journal of the International AIDS Society · 2026Article
- Pre-exposure prophylaxis use and discontinuation among Brazilian gay, bisexual, and other men who have sex with men: examining the role of internalized homonegativity and discrimination.BMC infectious diseases · 2025Article
- Article
- Updates on HIV Pre-exposure Prophylaxis in Latin America: Available Drugs and Implementation Status.Le infezioni in medicina · 2025Review
- Behind Prep Decisions: Understanding User Patterns and Discontinuation Factors in Real-World.AIDS and behavior · 2024Article
- Prevalence and factors associated with hepatitis B susceptibility among men who sex with men on HIV pre-exposure prophylaxis in Northeastern Brazil: a cross-sectional study.BMC infectious diseases · 2024Article
- Getting knowledge to provide care: prevalence and factors associated with Sexually Transmitted Infections in immigrants from Goiás.Revista da Escola de Enfermagem da U S P · 2024Article
- Procedural fairness in benefit package design: inclusion of pre-exposure prophylaxis of HIV in Universal Coverage Scheme in Thailand.Health policy and planning · 2023Article
- Implementation and resource needs for long-acting PrEP in low- and middle-income countries: a scoping review.Journal of the International AIDS Society · 2023Article
- Impact of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in urban centers in Brazil: a modeling study.BMC public health · 2023Article
- Out-of-pocket Expenses and Time Spent on Clinic Visits Among HIV Pre-exposure Prophylaxis Users and Other Clinic Attendees in Eswatini.AIDS and behavior · 2023Observational
- Cost-effectiveness evaluation of routine histoplasmosis screening among people living with advanced HIV disease in Latin America and the Caribbean.PLOS global public health · 2023Article
- Risks and benefits of oral HIV pre-exposure prophylaxis for people with chronic hepatitis B.The lancet. HIV · 2022Review
- Comparative Effectiveness of Interventions to Improve the HIV Continuum of Care and HIV Preexposure Prophylaxis in Kenya: A Model-Based Analysis.The Journal of infectious diseases · 2022Article
- Interest in Receiving HIV PrEP Among Biological Male Latinx Migrants at High-Risk of HIV Living in Mexico.Journal of health care for the poor and underserved · 2022Article
- Transporting Subgroup Analyses of Randomized Controlled Trials for Planning Implementation of New Interventions.American journal of epidemiology · 2021Article
- Mathematical Modelling of the Molecular Mechanisms of Interaction of Tenofovir with Emtricitabine against HIV.Viruses · 2021Article
- Impact of schooling in the HIV/AIDS prevalence among Brazilian transgender women.Archives of endocrinology and metabolism · 2020Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
introductionMen who have sex with men (MSM) and transgender women (TGW) in Brazil experience high rates of HIV infection. We examined the clinical and economic outcomes of implementing a pre-exposure prophylaxis (PrEP) programme in these populations.
methodsWe used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-International model of HIV prevention and treatment to evaluate two strategies: the current standard of care (SOC) in Brazil, including universal ART access (No PrEP strategy); and the current SOC plus daily tenofovir/emtracitabine PrEP (PrEP strategy) until age 50. Mean age (31 years, SD 8.4 years), age-stratified annual HIV incidence (age ≤ 40 years: 4.3/100 PY; age > 40 years: 1.0/100 PY), PrEP effectiveness (43% HIV incidence reduction) and PrEP drug costs ($23/month) were from Brazil-based sources. The analysis focused on direct medical costs of HIV care. We measured the comparative value of PrEP in 2015 United States dollars (USD) per year of life saved (YLS). Willingness-to-pay threshold was based on Brazil's annual per capita gross domestic product (GDP; 2015: $8540 USD).
resultsLifetime HIV infection risk among high-risk MSM and TGW was 50.5% with No PrEP and decreased to 40.1% with PrEP. PrEP increased per-person undiscounted (discounted) life expectancy from 36.8 (20.7) years to 41.0 (22.4) years and lifetime discounted HIV-related medical costs from $4100 to $8420, which led to an incremental cost-effectiveness ratio (ICER) of $2530/YLS. PrEP remained cost-effective (<1x GDP) under plausible variation in key parameters, including PrEP effectiveness and cost, initial cohort age and HIV testing frequency on/off PrEP.
conclusionDaily tenofovir/emtracitabine PrEP among MSM and TGW at high risk of HIV infection in Brazil would increase life expectancy and be highly cost-effective.
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