ArticleThe lancet. HIV2024
Impact of HIV self-testing for oral pre-exposure prophylaxis scale-up on drug resistance and HIV outcomes in western Kenya: a modelling study.
Article in The lancet. HIV, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Rapid diagnostic tests, laboratory-based immunoassay and nucleic acid testing strategies for long-acting injectable pre-exposure prophylaxis: A systematic review and meta-analysis.PLoS medicine · 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
- Investigating impact of theory of planned behavior-based educational intervention on HIV screening among healthcare staff.BMC health services research · 2025Trial
- Genetic Subtypes, Pretreatment Drug Resistance, and Associated Factors Among Individuals Newly Diagnosed With HIV-1 in Zhejiang Province From 2022 to 2024: Cross-Sectional Study.JMIR public health and surveillance · 2026Article
- A Darwinian model for the evolution of drug resistance to long-acting PrEP during an early HIV infection.PloS one · 2026Article
- Continuous antiretroviral therapy induces progressive senescence-like reprogramming of alveolar macrophages.Frontiers in immunology · 2026Article
- Estimated contributions and future mitigation strategies for HIV risk around funeral practices in western Kenya: a mathematical modeling study.BMC medicine · 2025Article
- Health and economic impact of oral PrEP provision across subgroups in western Kenya: a modelling analysis.BMJ global health · 2025Article
- Preferences for pre-exposure prophylaxis delivery via online pharmacy among potential users in Kenya: a discrete choice experiment.Journal of the International AIDS Society · 2024Article
- Breakthrough Acute HIV Infections among Pre-Exposure Prophylaxis Users with High Adherence: A Narrative Review.Viruses · 2024Review
- HIV self-testing, PrEP, and drug resistance: some insights.The lancet. HIV · 2024Article
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17 authors.
Funding
Abstract
backgroundCommunity-based oral pre-exposure prophylaxis (PrEP) provision has the potential to expand PrEP coverage. HIV self-testing can facilitate PrEP community-based delivery but might have lower sensitivity than facility-based HIV testing, potentially leading to inappropriate PrEP use among people with HIV and subsequent development of drug resistance. We aimed to evaluate the impact of HIV self-testing use for PrEP scale-up.
methodsWe parameterised an agent-based network model, EMOD-HIV, to simulate generic tenofovir disoproxil fumarate and emtricitabine PrEP scale-up in western Kenya using four testing scenarios: provider-administered nucleic acid testing, provider-administered rapid diagnostic tests detecting antibodies, blood-based HIV self-testing, or oral fluid HIV self-testing. Scenarios were compared with a no PrEP counterfactual. Individuals aged 18-49 years with one or more heterosexual partners who screened HIV-negative were eligible for PrEP. We assessed the cost and health impact of rapid PrEP scale-up with high coverage over 20 years, and the budget impact over 5 years, using various HIV testing modalities.
findingsPrEP coverage of 29% was projected to avert approximately 54% of HIV infections and 17% of HIV-related deaths among adults aged 18-49 years over 20 years; health impacts were similar across HIV testing modalities used to deliver PrEP. The percentage of HIV infections with PrEP-associated nucleoside reverse transcriptase inhibitor (NRTI) drug resistance was 0·6% (95% uncertainty intervals 0·4-0·9) in the blood HIV self-testing scenario and 0·8% (0·6-1·0) in the oral HIV self-testing scenario, compared with 0·3% (0·2-0·3) in the antibody rapid diagnostic testing scenario and 0·2% (0·1-0·2) in the nucleic acid testing scenario. Accounting for background NRTI resistance, we found similarly low proportions of drug resistance across scenarios. The budget impact of implementing PrEP using HIV self-testing and provider-administered rapid diagnostic tests were similar, while nucleic acid testing was approximately 50% more costly.
interpretationScaling up PrEP using HIV self-testing has similar health impacts, costs, and low risk of drug resistance as provider-administered rapid diagnostic tests. Policy makers should consider leveraging HIV self-testing to expand PrEP access among those at HIV risk.
fundingThe Bill and Melinda Gates Foundation.
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