Evidence map›Paper›PMID 31851759›Full record

ArticleThe Journal of infectious diseases2021

Potential Impact and Cost-Effectiveness of Condomless-Sex-Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance.

Andrew N Phillips, Valentina Cambiano, Leigh Johnson, Fumiyo Nakagawa, Rick Homan, Gesine Meyer-Rath, Thomas Rehle, Frank Tanser, Sizulu Moyo, Maryam Shahmanesh and 9 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 2 pooled it
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.

  1. Pooled it
  2. Evidence Gaps in Economic Evaluations of HIV Interventions Targeting Young People: A Systematic Review.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 13 institutions in 3 countries.

Andrew N PhillipsInstitute for Global Health, University College London, London, UK.
Valentina CambianoInstitute for Global Health, University College London, London, UK.
Leigh JohnsonCentre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Fumiyo NakagawaInstitute for Global Health, University College London, London, UK.
Rick HomanFHI 360, Durham, North Carolina, USA.
Gesine Meyer-RathDepartment of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Thomas RehleCentre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Frank TanserLincoln Institute for Health, University of Lincoln, Lincoln, UK.
Sizulu MoyoHuman Sciences Research Council, Pretoria, South Africa.
Maryam ShahmaneshInstitute for Global Health, University College London, London, UK.
Delivette CastorUnited States Agency for International Development, Washington, District of Columbia, USA.
Elizabeth RussellUnited States Agency for International Development, Washington, District of Columbia, USA.
Lise JamiesonDepartment of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Loveleen Bansi-MatharuInstitute for Global Health, University College London, London, UK.
Amir ShroufiMedécins Sans Frontières, Cape Town, South Africa.
Ruanne V BarnabasUniversity of Washington, Seattle, Washington, USA.
Urvi M ParikhUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA.
John W MellorsUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Paul RevillUniversity of York, York, UK.
University College London · GBUnited States Agency for International Development · USUniversity of Cape Town · ZAUniversity of Pittsburgh · USAfrica Health Research Institute · ZABoston University · USCentre for the AIDS Programme of Research in South Africa · ZAFamily Health International 360 · USHuman Sciences Research Council · ZAMédecins Sans Frontières · ZAUniversity of the Witwatersrand · ZAUniversity of Washington · USUniversity of York · GB

Funding

University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI EDWIN ROBERTO ORELLANA · 1988 to 2026
$104.9M
Maximizing combination HIV prevention, uptake and retention by adolescent girls and young womenR01MH114560 · NIMH · KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV · PI SHAHMANESH, MARYAM · 2017 to 2023
$2.0M
Medical Research Council MR/T042796/1NIAID NIH HHS P30 AI027757NIMH NIH HHS R01 MH114560
6 · The paper itself

Abstract

introductionOral preexposure prophylaxis (PrEP) in the form of tenofovir-disoproxil-fumarate/emtricitabine is being implemented in selected sites in South Africa. Addressing outstanding questions on PrEP cost-effectiveness can inform further implementation.

methodsWe calibrated an individual-based model to KwaZulu-Natal to predict the impact and cost-effectiveness of PrEP, with use concentrated in periods of condomless sex, accounting for effects on drug resistance. We consider (1) PrEP availability for adolescent girls and young women aged 15-24 years and female sex workers, and (2) availability for everyone aged 15-64 years. Our primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programs.

resultsIn the context of PrEP use in adults aged 15-64 years, there was a predicted 33% reduction in incidence and 36% reduction in women aged 15-24 years. PrEP was cost-effective, including in a range of sensitivity analyses, although with substantially reduced (cost) effectiveness under a policy of ART initiation with efavirenz- rather than dolutegravir-based regimens due to PrEP undermining ART effectiveness by increasing HIV drug resistance.

conclusionsPrEP use concentrated during time periods of condomless sex has the potential to substantively impact HIV incidence and be cost-effective.

Indexed as

Anti-HIV AgentsHIV InfectionsPre-Exposure ProphylaxisSex WorkersUnsafe SexAdolescentAdultCost-Benefit AnalysisDrug ResistanceEmtricitabineFemaleHumansMaleMiddle AgedModels, TheoreticalSouth AfricaAnti-HIV AgentsEmtricitabinecostcost-effectiveness analysisdrug resistanceHIVindividual-basedmodelPrEPSouth Africa

Identifiers

PMID31851759
PMCPMC8064039
OpenAlexW2994793828

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.