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Project Details

What is the Best Use of Pre-Exposure Prophylaxis in Africa?

African woman and baby in a pond
Project Summary: 

Using a deterministic, compartmental model for HIV transmission, we estimated the incremental impact after five years of using pre-exposure prophylaxis (PrEP) among the adult population in 42 Subsaharan African countries.

We assumed an efficacy of 68%, adherence of 80%; coverage the same as currently for ART, and annual cost of PrEP of $150 per person. After five years, PrEP averted more than 950,000 HIV infections; 25% in South Africa. Average Incremental cost-effectiveness would be 8,051 US$/DALY and ranges from 831 US$/DALYs in Lesotho to 92,678 US$/DALY in Eritrea. PrEP will have its maximum impact and be most cost-effective where HIV prevalence is high and male circumcision is low, but combined with multiple strategies to control the HIV pandemic.

Main Findings: 

Pre-Exposure Prophylaxis for HIV in 42 Subsaharan countries is remarkably cost effective where HIV transmission is highest and male circumcision is lowest when compliance and adherence to the regimen is at least 80%.

Policy, Practice or Research Impacts: 

Where HIV transmission is high and male circumcision is low, then Pre-Exposure Prophylaxis can cost-effectively avert substantial new HIV infections, however this requires compliance with this treatment regimen to average 80%.

Contact Person: 
Julia Walsh
Contact Person's Email Address:
Global Health, Maternal and Child Health, Community Health and Human Development
Principal Investigators: 
Julia Walsh, Stephane Verguet
Research Publications and Reports: 

submitted for publication Feb 2012

Stephane Verguet, PhD, MPP, University of Washington Institute for Health Metrics and Evaluation
Location - Countries: 
Subsaharan Africa
Publication Date: