Evidence map›Paper›PMID 40205318›Full record

ArticlePharmacoEconomics - open2025

Cost-Effectiveness of Using Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence Among Male Sex Workers.

Carlos Chivardi, Alejandro Zamudio-Sosa, Marta Wilson-Barthes, Fernando Alarid-Escudero, Monica Gandhi, Kenneth H Mayer, Don Operario, Omar Galárraga

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PharmacoEconomics - open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03674983 (PrEP Seguro), which is not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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.

NCT03674983 nacompletednot on this map

PrEP Seguro: Antiretroviral-based HIV Prevention Among Men at High Risk in Mexico

TypeinterventionalSponsorBrown UniversityRan2019 to 2021Enrolled310ConditionsHIV InfectionsArmsConditional Economic Incentive (CEI)
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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

8 authors.

Carlos ChivardiCentre for Health Economics, University of York, York, UK.
Alejandro Zamudio-SosaNational Autonomous University of Mexico (UNAM), Mexico City, Mexico.ORCID http://orcid.org/0000-0002-3902-5585
Marta Wilson-BarthesInternational Health Institute, Brown University School of Public Health, Providence, RI, USA.ORCID http://orcid.org/0000-0002-9845-7142
Fernando Alarid-EscuderoHealth Policy, Stanford University School of Medicine, Stanford, CA, USA.
Monica GandhiDepartment of Medicine, University of California San Francisco, San Francisco, CA, USA.
Kenneth H MayerThe Fenway Institute, Fenway Health, and Harvard University, Boston, MA, USA.
Don OperarioRollins School of Public Health, Emory University, Atlanta, GA, USA.
Omar GalárragaDepartment of Health Services, Policy and Practice & International Health Institute, Brown University School of Public Health, Providence, RI, USA. omar_galarraga@brown.edu.ORCID http://orcid.org/0000-0002-9985-9266

Funding

“Hair Lengthening”: Using Hair Levels to Interpret Long-Acting PrEP Studies.R37AI098472 · NIAID · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Monica Gandhi · 2023 to 2026
$3.2M
PrEP Seguro: Antiretrovial-based HIV prevention among men at high risk in MexicoR34MH114664 · NIMH · BROWN UNIVERSITY · PI GALARRAGA, OMAR · 2017 to 2019
$638k
NIAID NIH HHS R37 AI098472NIMH NIH HHS R34 MH114664NIMH NIH HHS R34MH114664
6 · The paper itself

Abstract

introductionConditional economic incentives can improve medication-taking behaviors among populations at risk of contracting human immunodeficiency virus (HIV). However, there are no data on the cost-effectiveness of incentive programs for improving pre-exposure prophylaxis (PrEP) adherence among male sex workers (MSWs) who have one of the highest HIV acquisition rates. Our objective was to assess the cost-effectiveness of incentive programs to improve adherence to pre-exposure prophylaxis (PrEP) among male sex workers

methodsWe conducted an economic evaluation of the PrEP Seguro randomized pilot trial in Mexico (ClinicalTrials.gov: NCT03674983). Among n = 110 MSWs, those randomized to the intervention received tiered incentives based on PrEP drug levels in scalp hair measured at three clinic visits over 6 months. The intervention led to a 28.7% increase in scalp hair PrEP concentration, consistent with increased adherence (p = 0.05). Here we use a micro-costing approach from the health system perspective to calculate costs. Quality-adjusted life years (QALYs) were estimated from the number of HIV infections averted through sufficient PrEP adherence (tenofovir concentration > 0.011 ng/mg corresponding to greater than or equal to three weekly doses). Incremental cost-effectiveness ratios (ICERs) estimated the cost/QALY gained owing to the intervention.

resultsThe mean cost per patient was US $165.53 and $179.55 among standard care and incentive patients, respectively. Over 6 months of follow-up, 62% of standard care patients and 78% of incentive recipients were PrEP adherent. After the program, the lifetime average QALYs gained per infection avoided were 9.17 (minimum, maximum: 7.5, 10.8) and 9.84 (minimum, maximum: 8.05, 11.6) among standard care and incentive patients, respectively. The 6-month ICER was US $20.92/QALY gained by the intervention, which was highly cost-effective at a willingness-to-pay of US $8655 (Mexico's 2020 per capita gross domestic product (GDP)). DISCUSSION: Using behavioral economics approaches for enhancing adherence to HIV prevention may offer health and fiscal benefits through reduced HIV incidence. Fully powered implementation trials can determine future cost-effectiveness of scaling up incentives for PrEP adherence among high-risk populations.

Identifiers

PMID40205318
PMCPMC12209064

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Registered trials

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.