ArticleBMC medicine2018
The cost-effectiveness of oral HIV pre-exposure prophylaxis and early antiretroviral therapy in the presence of drug resistance among men who have sex with men in San Francisco.
Article in BMC medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Prospects of HIV elimination among men who have sex with men: A systematic review of modeling studies.PLoS computational biology · 2026Pooled 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
- Infectious Disease Modelling of HIV Prevention Interventions: A Systematic Review and Narrative Synthesis of Compartmental Models.PharmacoEconomics · 2023Pooled it
- Cost-effectiveness of concurrently available oral and long-acting injectable pre-exposure prophylaxis for preventing HIV infections among men who have sex with men in eastern China: A modelling study.BMC public health · 2026Article
- Cost-effectiveness of a smart pillbox intervention for adherence to oral HIV pre-exposure prophylaxis.Nature communications · 2026Article
- Cost-Effectiveness Analysis of Recombinant Tumor Necrosis Factor Receptor: Fc Fusion Protein as First-Line Treatment for Active Rheumatoid Arthritis in China.Healthcare (Basel, Switzerland) · 2025Article
- Cost-effectiveness of eHealth-based HIV pre-exposure intervention for recreational drugs using among men who have sex with men in China: a modelling study.BMC public health · 2025Article
- Real-time digital intervention on oral pre-exposure prophylaxis adherence among MSM: randomized controlled trial.NPJ digital medicine · 2025Article
- Data fitting and optimal control strategies for HBV acute patient cases in the United States.Infectious Disease Modelling · 2025Article
- A modeling study of pre-exposure prophylaxis to eliminate HIV in Taiwan by 2030.Communications medicine · 2025Article
- Daily Oral HIV Pre-exposure Prophylaxis Among Young Men Who Have Sex With Men in the United States: Cost-saving at Generic Drug Price.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Are Unequal Policies in Pre-Exposure Prophylaxis Uptake Needed to Improve Equality? An Examination Among Men Who Have Sex with Men in Los Angeles County.AIDS patient care and STDs · 2022Article
- Finding and treating early-stage HIV infections: A cost-effectiveness analysis of theLancet regional health. Americas · 2022Article
- The Italian PrEPventHIV challenge: a scoping systematic review on HIV pre-exposure prophylaxis monitoring in Italy.Acta bio-medica : Atenei Parmensis · 2022Article
- The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review.AIDS and behavior · 2022Article
- Cost-effectiveness of oral pre-exposure prophylaxis and expanded antiretroviral therapy for preventing HIV infections in the presence of drug resistance among men who have sex with men in China: A mathematical modelling study.The Lancet regional health. Western Pacific · 2022Article
- Evaluating the cost-effectiveness of a pre-exposure prophylaxis program for HIV prevention for men who have sex with men in Japan.Scientific reports · 2022Article
- Added Benefits of Pre-Exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement Among Men Who Have Sex with Men.AIDS patient care and STDs · 2020Article
- Efficacy and cost-effectiveness of early antiretroviral therapy and partners' pre-exposure prophylaxis among men who have sex with men in Shenyang, China: a prospective cohort and costing study.BMC infectious diseases · 2019Article
- Review of Real-World Implementation Data on Emtricitabine-Tenofovir Disoproxil Fumarate as HIV Pre-exposure Prophylaxis in the United States.Pharmacotherapy · 2019Review
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundPoor adherence to either antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) can promote drug resistance, though this risk is thought to be considerably higher for ART. In the population of men who have sex with men (MSM) in San Francisco, PrEP coverage reached 9.6% in 2014 and has continued to rise. Given the risk of drug resistance and high cost of second-line drugs, the costs and benefits of initiating ART earlier while expanding PrEP coverage remain unclear.
methodsWe develop an infection-age-structured mathematical model and fit this model to the annual incidence of AIDS cases and deaths directly, and to resistance and demographic data indirectly. We investigate the impact of six various intervention scenarios (low, medium, or high PrEP coverage, with or without earlier ART) over the next 20 years.
resultsLow (medium, high) PrEP coverage with earlier ART could prevent 22% (42%, 57%) of a projected 44,508 total new infections and 8% (26%, 41%) of a projected 18,426 new drug-resistant infections, and result in a gain of 43,649 (74,048, 103,270) QALYs over 20 years compared to the status quo, at a cost of $4745 ($78,811, $115,320) per QALY gained, respectively.
conclusionsHigh PrEP coverage with earlier ART is expected to provide the greatest benefit but also entail the highest costs among the strategies considered. This strategy is cost-effective for the San Francisco MSM population, even considering the acquisition and transmission of ART-mediated drug resistance. However, without a substantial increase to San Francisco's annual HIV budget, the most advisable strategy may be initiating ART earlier, while maintaining current strategies of PrEP enrollment.
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