Abstract | BACKGROUND: Biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus ( HIV) infection. However, China has not released national PrEP guidelines, and HIV incidence among men who have sex with men (MSM) is unchanged despite substantial scale-up of ART. We evaluated reductions in HIV transmission that may be achieved through early initiation of ART plus partners' PrEP. METHODS: Six intervention scenarios were evaluated in terms of their impact on HIV transmission and their cost-effectiveness for 36 months post- infection. Three scenarios were based on observed data: non-ART, standard-ART, and early-ART. Another three scenarios were based on observed and hypothetical data: non-ART plus partners' PrEP, standard-ART plus partners' PrEP, and early-ART plus partners' PrEP. The number of onward transmissions was calculated according to viral load and self-reported sexual behaviors, and calibrated by the prevalence and incidence of HIV among Chinese MSM. Cost-effectiveness outcomes were quality-adjusted life-years (QALYs) and cost-utility ratio (CUR). RESULTS: The estimated number of onward transmissions by every 100 HIV-positive cases 36 months post- infection was 41.83 (95% credible interval: 30.75-57.69) in the non-ART scenario, 7.95 (5.85-10.95) in the early-ART scenario, and 0.79 (0.58-1.09) in the early-ART plus partners' PrEP scenario. Compared with non-ART, the early-ART and early-ART plus partners' PrEP scenarios were associated with an 81.0 and 98.1% reduction in HIV transmission, and had a CUR of $12,864/QALY and $16,817/QALY, respectively. CONCLUSIONS: Integrated delivery of early ART and sexual partners' PrEP could nearly eliminate HIV transmission and reduce costs during the first 36 months of HIV infection. Our results suggest a feasible and cost-effective strategy for reversing the HIV epidemic among MSM in China.
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Authors | Qing-Hai Hu, Kathrine Meyers, Jun-Jie Xu, Zhen-Xing Chu, Jing Zhang, Hai-Bo Ding, Xiao-Xu Han, Yong-Jun Jiang, Wen-Qing Geng, Hong Shang |
Journal | BMC infectious diseases
(BMC Infect Dis)
Vol. 19
Issue 1
Pg. 663
(Jul 25 2019)
ISSN: 1471-2334 [Electronic] England |
PMID | 31345169
(Publication Type: Journal Article)
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Chemical References |
- Anti-HIV Agents
- Anti-Retroviral Agents
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Topics |
- Adult
- Aged
- Anti-HIV Agents
(therapeutic use)
- Anti-Retroviral Agents
(economics, therapeutic use)
- China
- Cohort Studies
- Cost-Benefit Analysis
- HIV Infections
(economics, prevention & control)
- HIV Seropositivity
(drug therapy)
- Homosexuality, Male
(statistics & numerical data)
- Humans
- Incidence
- Male
- Middle Aged
- Pre-Exposure Prophylaxis
(economics, methods)
- Prevalence
- Prospective Studies
- Quality-Adjusted Life Years
- Secondary Prevention
(economics)
- Treatment Outcome
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