Preventing HIV infection with anti-HIV drugs in people at risk is cost-effective

Press release from PLOS Medicine

2013-03-13

(Press-News.org) An HIV prevention strategy in which people at risk of becoming exposed to HIV take antiretroviral drugs to reduce their chance of becoming infected (often referred to as pre-exposure prophylaxis or PrEP), may be a cost-effective method of preventing HIV in some settings, according to a study by international researchers published in this week's PLOS Medicine.

In an analysis of 13 modelling studies led by Gabriela Gomez from the Department of Global Health, Academic Medical Centre, University of Amsterdam/AIGHD in The Netherlands, the authors evaluated the impact of pre-exposure prophylaxis in different populations (heterosexual couples, men who have sex with men, and people who inject drugs) in different regions and countries, such as southern Africa, Ukraine, the US, and Peru.

They found that in every setting, the cost of antiretroviral drugs was an important factor influencing the affordability of effective prevention programmes but delivery of pre-exposure prophylaxis to populations at higher risk of HIV exposure appeared to be the most cost-effective strategy. The authors also found that both behavioural changes and adherence to the pre-exposure prophylaxis drug regimens affected programme effectiveness.

The authors say: "Our findings show that pre-exposure prophylaxis has the potential to be a cost-effective addition to HIV prevention programmes in some settings."

They continue: "However, the cost-effectiveness of pre-exposure prophylaxis is likely to depend on considerations such as cost, the epidemic context, pre-exposure prophylaxis programme coverage and prioritisation strategies, as well as individual adherence levels and pre-exposure prophylaxis efficacy estimates."

The authors add: "Given that our review shows that both the setting and which population is prioritised for pre-exposure prophylaxis are critical drivers of cost-effectiveness, the next step is to conduct context-specific demonstration studies, including comprehensive cost analyses, of different prioritisation and adherence promotion strategies to ensure that the maximum benefit from the introduction of pre-exposure prophylaxis is realised within combination HIV prevention programmes."

### Funding: During the preparation of this manuscript, AB was supported by a grant from UK Medical Research Council and AW was funded by the NIHR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors declare that no competing interests exist. GBG and AB are authors of one of the primary studies reviewed.

Citation: Gomez GB, Borquez A, Case KK, Wheelock A, Vassall A, et al. (2013) The Cost and Impact of Scaling Up Pre-exposure Prophylaxis for HIV Prevention: A Systematic Review of Cost-Effectiveness Modelling Studies. PLoS Med 10(3): e1001401. doi:10.1371/journal.pmed.1001401

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001401

Contact:

Gabriela B. Gomez
Department of Global Health, Academic Medical Centre
University of Amsterdam and Amsterdam Institute for Global Health and Development
The Netherlands
g.gomez@aighd.org END

ELSE PRESS RELEASES FROM THIS DATE:

Use of adjunctive antipsychotic medications in depression

2013-03-13

A study published this week in PLOS Medicine finds that while antipsychotic medications are associated with small-to-moderate improvements in depressive symptoms in adults, there is little evidence for improvement on measures of quality of life and these medications are linked to adverse events such as weight gain and sedation. The results of the study, conducted by Glen Spielmans of Metropolitan State University in St. Paul, Minnesota and colleagues, have potential implications for the treatment of depression by providing clinicians with a better understanding of the ...

Ethical oversight needed for social network health research

2013-03-13

Participant-led research, such as studies conducted via social networks, are increasingly common and have several advantages over more standard research but there are some concerns about their ethical oversight, according to experts writing in this week's PLOS Medicine. Effy Vayena from the University of Zurich in Switzerland and John Tasioulas from University College London argue that the distinctive nature of such participant-led research means that the standards of ethical oversight should be adapted to strike a balance between protecting the interests of research ...

Implementing e-health in Malawi

2013-03-13

In low-income countries a substantial challenge in planning and delivering healthcare is the accurate assessment of disease burden. In this week's PLOS Medicine, Miguel SanJoaquin from the University of Malawi College of Medicine and colleagues describe their experience of implementing an electronic patient record system in a large referral hospital in southern Malawi. The system, known as Surveillance Programme of IN-patients and Epidemiology (SPINE), is used to record patient details during consultations and this data can be used to monitor changing patterns of disease ...

Using fat to fight brain cancer

2013-03-13

In laboratory studies, Johns Hopkins researchers say they have found that stem cells from a patient's own fat may have the potential to deliver new treatments directly into the brain after the surgical removal of a glioblastoma, the most common and aggressive form of brain tumor. The investigators say so-called mesenchymal stem cells (MSCs) have an unexplained ability to seek out damaged cells, such as those involved in cancer, and may provide clinicians a new tool for accessing difficult-to-reach parts of the brain where cancer cells can hide and proliferate anew. The ...

Despite weight gain, quitting smoking associated with reduced risk of cardiovascular disease

2013-03-13

Among adults without diabetes, quitting smoking, compared with continuing smoking, was associated with a lower risk of cardiovascular disease despite subsequent weight gain, according to a study appearing in the March 13 issue of JAMA. "Cigarette smoking is the leading cause of preventable mortality in the United States and a major risk factor for cardiovascular disease (CVD). Smoking cessation substantially reduces the risks of CVD; however, quitting smoking is associated with a small number of adverse health consequences, weight gain being one of smokers' major concerns," ...

Duration of breastfeeding during infancy does not reduce a child's risk of being overweight, obese

2013-03-13

In research that included nearly 14,000 healthy infants in Belarus, an intervention that succeeded in improving the duration and exclusivity of breastfeeding during infancy did not result in a lower risk of overweight or obesity among the children at age 11.5 years, according to a study appearing in the March 13 issue of JAMA. Observational studies suggest that greater duration and exclusivity of having been breastfed reduces child obesity risk. "However, breastfeeding and growth are socially patterned in many settings," and observed associations between these variables ...

Study examines outcomes for treatment of sleep apnea with primary care vs. specialist care

2013-03-13

Among patients who were identified as likely having moderate to severe obstructive sleep apnea, treatment based in primary care was not clinically inferior to treatment at a specialist sleep center for improvement in daytime sleepiness scores, according to a study appearing in the March 13 issue of JAMA. "Obstructive sleep apnea with accompanying daytime sleepiness was estimated during the early 1990s to affect between 2 percent and 4 percent of middle-aged adults. With growing awareness of the public health implications of untreated disease and rising obesity rates ...

Major bleeding following PCI associated with increased risk of death

2013-03-13

In a study that included 3.3 million percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) procedures, major bleeding after PCI was associated with significantly increased in-hospital mortality, with an estimated 12 percent of deaths after PCI related to bleeding complications, according to a study appearing in the March 13 issue of JAMA. "Bleeding represents the most common noncardiac complication of PCI. Postprocedural bleeding is associated with short- and long-term death, nonfatal ...

Weight gain after quitting smoking does not negate health benefits

2013-03-13

An analysis of data from the Framingham Offspring Study – a long-term study that follows children of participants in the original Framingham Heart Study – may have answered a question that has troubled individuals considering stopping smoking: do the health effects of any weight gained after quitting outweigh the known cardiovascular benefits of smoking cessation? The report in the March 13 issue of JAMA concludes that the benefits of stopping smoking far exceed any weight-gain associated risk. "Among people without diabetes, those who stopped smoking had a 50 percent ...

Fertility after ectopic pregnancy: Study finds reassuring evidence on different treatments

2013-03-13

The first randomised trial to compare treatments for ectopic pregnancies has found no significant differences in subsequent fertility between medical treatment and conservative surgery on one hand, and conservative or radical surgery on the other. The study, which is published online today (Wednesday) in Europe's leading reproductive medicine journal Human Reproduction [1], compared three ways of treating an ectopic pregnancy: medically by methotrexate injection to interrupt pregnancy in the Fallopian tube; conservative surgery, which preserves the Fallopian tube (known ...

Preventing HIV infection with anti-HIV drugs in people at risk is cost-effective

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: