Potential Impact and Cost-Effectiveness of Condomless-Sex–Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance

By Andrew N. Phillips, Valentina Cambiano, Leigh Johnson, Fumiyo Nakagawa, Rick Homan,  Dr Gesine Meyer-Rath  Lise Jamieson  Loveleen Bansi-Matharu, Amir Shroufi, Ruanne V. Barnabas, Urvi M. Parikh, John W. Mellors, and Paul Revill  |  | 

Introduction. Oral preexposure 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 (1) PrEP availability for adolescent
girls and young women aged 15–24 years and female sex workers, and (2) availability for everyone aged 15–64 years. Our
primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programs

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