1. Health impact, budget impact, and price threshold for cost-effectiveness of lenacapavir for HIV pre-exposure prophylaxis in eastern and southern Africa: a modelling analysis.
- Author
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Wu L, Kaftan D, Wittenauer R, Arrouzet C, Patel N, Saravis AL, Pfau B, Mudimu E, Bershteyn A, and Sharma M
- Subjects
- Humans, Male, Female, Adolescent, Adult, Young Adult, Budgets, Africa, Southern epidemiology, Africa, Eastern epidemiology, Sex Workers, HIV Infections prevention & control, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections economics, Pre-Exposure Prophylaxis economics, Pre-Exposure Prophylaxis methods, Cost-Benefit Analysis, Anti-HIV Agents economics, Anti-HIV Agents administration & dosage, Anti-HIV Agents therapeutic use
- Abstract
Background: Injectable lenacapavir administered every 6 months is a promising product for HIV pre-exposure prophylaxis (PrEP). We aimed to estimate the health and budget impacts and threshold price at which lenacapavir could be cost-effective in eastern and southern Africa., Methods: We adapted an agent-based network model, EMOD-HIV, to simulate lenacapavir scale-up in Zimbabwe, South Africa, and western Kenya from 2026 to 2035. Uptake assumptions were informed by a literature review of PrEP product preferences. In the main analysis, we varied lenacapavir coverage by subgroup: female sex workers (40% coverage); male clients of female sex workers (40%); adolescent girls and young women aged 15-24 years with more than one sexual partner (32%); women aged 25 years and older with more than one sexual partner (36%); and males with more than one sexual partner (32%). We also assessed a higher coverage scenario (64-76% across subgroups) and scenarios of expanding lenacapavir use, varying from concentrated among those at highest HIV risk to broader coverage including those at medium HIV risk. We estimated the maximum per-dose lenacapavir price that achieved cost-effectiveness (
- Published
- 2024
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