ArticleJournal of the International AIDS Society2023
Impact and cost-effectiveness of the national scale-up of HIV pre-exposure prophylaxis among female sex workers in South Africa: a modelling analysis.
Article in Journal of the International AIDS Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 12 papers, 2 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.
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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
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- 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
- HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis.The Lancet. Global health · 2024Pooled it
- Epidemiological impacts and cost-effectiveness of daily and on-demand oral pre-exposure prophylaxis among key HIV populations in China: An economic evaluation.Epidemiology and infection · 2025Article
- The impact of cuts in the US President's Emergency Plan for AIDS Relief funding for HIV pre-exposure prophylaxis in sub-Saharan Africa: a modelling study.The lancet. HIV · 2025Article
- Cost-effective pricing of long-acting injectable HIV pre-exposure prophylaxis for adolescent girls and young women in South Africa: a model-based analysis.The Lancet. Global health · 2025Article
- The changing cost-effectiveness of primary HIV prevention: simple calculations of direct effects.Journal of the International AIDS Society · 2025Article
- Cost-effectiveness of health insurance among women engaged in transactional sex and impacts on HIV transmission in Cameroon: a mathematical model.BMJ global health · 2025Article
- Oral pre-exposure prophylaxis implementation in South Africa: a case study of USAID-supported programs.Frontiers in reproductive health · 2024Article
- HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis.medRxiv : the preprint server for health sciences · 2023Article
- ERRATUM.Journal of the International AIDS Society · 2023Article
- Implementation considerations for long-acting injectable PrEP rollout among female sex workers in South Africa: A qualitative analysis guided by the Consolidated Framework for Implementation Research.Women's health (London, England)Article
- Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda: a community-based cross-sectional study.Therapeutic advances in infectious diseaseArticle
Corrections and comments
- Erratum issuedERRATUM.2023
Authors and funding
17 authors at 8 institutions in 4 countries.
Funding
Abstract
introductionIn 2016, South Africa (SA) initiated a national programme to scale-up pre-exposure prophylaxis (PrEP) among female sex workers (FSWs), with ∼20,000 PrEP initiations among FSWs (∼14% of FSW) by 2020. We evaluated the impact and cost-effectiveness of this programme, including future scale-up scenarios and the potential detrimental impact of the COVID-19 pandemic.
methodsA compartmental HIV transmission model for SA was adapted to include PrEP. Using estimates on self-reported PrEP adherence from a national study of FSW (67.7%) and the Treatment and Prevention for FSWs (TAPS) PrEP demonstration study in SA (80.8%), we down-adjusted TAPS estimates for the proportion of FSWs with detectable drug levels (adjusted range: 38.0-70.4%). The model stratified FSW by low (undetectable drug; 0% efficacy) and high adherence (detectable drug; 79.9%; 95% CI: 67.2-87.6% efficacy). FSWs can transition between adherence levels, with lower loss-to-follow-up among highly adherent FSWs (aHR: 0.58; 95% CI: 0.40-0.85; TAPS data). The model was calibrated to monthly data on the national scale-up of PrEP among FSWs over 2016-2020, including reductions in PrEP initiations during 2020. The model projected the impact of the current programme (2016-2020) and the future impact (2021-2040) at current coverage or if initiation and/or retention are doubled. Using published cost data, we assessed the cost-effectiveness (healthcare provider perspective; 3% discount rate; time horizon 2016-2040) of the current PrEP provision.
resultsCalibrated to national data, model projections suggest that 2.1% of HIV-negative FSWs were currently on PrEP in 2020, with PrEP preventing 0.45% (95% credibility interval, 0.35-0.57%) of HIV infections among FSWs over 2016-2020 or 605 (444-840) infections overall. Reductions in PrEP initiations in 2020 possibly reduced infections averted by 18.57% (13.99-23.29). PrEP is cost-saving, with $1.42 (1.03-1.99) of ART costs saved per dollar spent on PrEP. Going forward, existing coverage of PrEP will avert 5,635 (3,572-9,036) infections by 2040. However, if PrEP initiation and retention doubles, then PrEP coverage increases to 9.9% (8.7-11.6%) and impact increases 4.3 times with 24,114 (15,308-38,107) infections averted by 2040.
conclusionsOur findings advocate for the expansion of PrEP to FSWs throughout SA to maximize its impact. This should include strategies to optimize retention and should target women in contact with FSW services.
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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.