By the same authors

From the same journal

Potential impact and cost-effectiveness of condomless-sex-concentrated PrEP in KwaZulu-Natal accounting for drug resistance

Research output: Contribution to journalArticle


  • Andrew Phillips
  • Valentina Cambiano
  • Leigh Johnson
  • Fumiyo Nakagawa
  • Rick Homan
  • Gesine Meyer-Rath
  • Thomas Rehle
  • Frank Tanser
  • Sizulu Moyo
  • Maryam Shahmanesh
  • Delivette Castor
  • Elizabeth Russell
  • Lise Jamieson
  • Loveleen Bansi-Matharu
  • Amir Shroufi
  • Ruanne Barnabas
  • Urvi M Parikh
  • John W Mellors
  • Paul Revill


Publication details

JournalThe Journal of Infectious Diseases
DateE-pub ahead of print - 18 Dec 2019
Original languageEnglish


INTRODUCTION: Oral pre-exposure 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.

METHODS: We 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 (i) PrEP availability for adolescent-girls-and-young-women (aged 15-24; AGYW) and female sex workers (FSW), and (ii) availability for everyone aged 15-64. Our primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programmes.

RESULTS: In the context of PrEP use in adults aged 15-64 there was a predicted 33% reduction in incidence, and 36% reduction in women aged 15-24. 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.

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

Bibliographical note

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

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