The impact of self-selection based on HIV risk on the cost-effectiveness of preexposure prophylaxis in South Africa

By  Lise Jamieson  Gabriela B. Gomez, Kevin Rebe, Ben Brown, Hasina Subedar, Sarah Jenkins, Natsai Shoko, Linda-Gail Bekker, Leigh F. Johnson  Dr Gesine Meyer-Rath  |  | 

This study aims to determine the cost-effectiveness of provision of daily oral PrEP in South Africa, a setting with
one of the highest HIV prevalence levels in the world, whereas considering the possibility that those at higher risk
of contracting HIV may self-select into the PrEP programme. Our focus on self-selection over supply-side targeting was informed by the TWG’s preference that a risk screening tool should not be used to determine whether an individual receives PrEP, to avoid stigmatizing PrEP as an intervention reserved for those with higher risk behaviour
and to not exclude anybody who perceive themselves to be at HIV risk. Existing risk-scoring tools for HIV often have
low sensitivity and/or specificity, leading to mis-classification of those at risk of HIV [25–27].

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Wolters Kluwer Health, Inc