Seasonal PrEP for partners of migrant miners in southern Mozambique: a highly focused PrEP intervention

Abstract

IntroductionTo be used most effectively, pre-exposure prophylaxis (PrEP) should be prioritized to those at high risk of acquisition and would ideally be aligned with time periods of increased exposure. Identifying such time periods is not always straightforward, however. Gaza Province in southern Mozambique is characterized by high levels of HIV transmission and circular labour migration to mines in South Africa. A strong seasonal pattern in births is observable, reflecting an increase in conception in December. Given the potential for increased HIV transmission between miners returning in December and their partners in Gaza Province, PrEP use by the latter would be a useful means of HIV prevention, especially for couples who wish to conceive.MethodsA mathematical model was used to represent population-level adult heterosexual HIV transmission in Gaza Province. Increased HIV acquisition among partners of miners in December, coinciding with the miners’ return from South Africa, is represented. In addition to a PrEP intervention, the scale-up of treatment and recent scale-up of male circumcision that have occurred in Gaza are represented.ResultsProviding time-limited PrEP to the partners of migrant miners, as opposed to providing PrEP all year, would improve the cost per infection averted by 7.5-fold. For the cost per infection averted to be below US$3000, at least 85% of PrEP users would need to be good adherers and PrEP would need to be cheaper than US$115 per person per year. Uncertainty regarding incidence of HIV transmission among partners of miners each year in December has a strong influence on estimates of cost per infection averted.ConclusionsProviding time-limited PrEP to partners of migrant miners in Gaza Province during periods of increased exposure would be a novel strategy for providing PrEP. This strategy would allow for a better prioritized intervention, with the potential to improve the efficiency of a PrEP intervention considerably, as well as providing important reproductive health benefits.

The impact, cost and cost‐effectiveness of oral pre‐exposure prophylaxis in sub‐Saharan Africa: a scoping review of modelling contributions and way forward

“…These studies span from 2007 to 2017 with 42 studies modelling oral PrEP in sub‐Saharan Africa and two studies with non‐specific settings but of relevance for generalized HIV epidemics. Applications of country‐specific modelling of oral PrEP occurred predominantly for South Africa and Kenya , followed by Botswana , Zambia , and one application each for Zimbabwe , Mozambique , Nigeria , and Uganda . Select country‐specific results were additionally presented in two studies .…”

“…Two modelling studies investigated the impact in South Africa of short‐term PrEP for the HIV‐negative partner, prior to viral suppression in the HIV‐positive partner, and found this was a cost‐effective , and potentially cost‐saving , intervention in this setting. In Kampala, Uganda, an intervention of PrEP and ART targeted to 90% of high‐risk serodiscordant couples just exceeded the cost‐effectiveness threshold, but the timeframe of this analysis (10 years) may have been insufficient to fully capture the effects of PrEP on DALYs averted .…”

“…The assumptions used for the annual cost of PrEP in the studies in Nigeria and South Africa fall near the midpoint of the Ying et al . estimates, with a PrEP cost of $233 per patient‐year assumed in the Nigeria study , and $200 (range $150 to 250) and $250 per patient‐year assumed in the South African studies. Additional File details the assumed costs for PrEP and ART across studies.…”

Cost and cost‐effectiveness analysis of pre‐exposure prophylaxis among men who have sex with men in two hospitals in Thailand

“…We searched PubMed from 1 January 2013 to 11 October 2017 with the terms "HIV" AND ("PrEP" OR "PrEP") AND ("cost" OR "costeffectiveness") with the goal of identifying any new studies that have appeared since the 2013 meta-analysis of PrEP cost-effectiveness modelling studies [32]. The search retrieved 149 abstracts, of which 21 provided country-specific estimates of the cost-effectiveness of various PrEP implementation strategies [6,8,9,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. This study is not only the first to provide data and evidence on the costs and cost-effectiveness of providing oral PrEP to MSM in Thailand, but is also the first such study from the Asia-Pacific region.…”

Modeling and Cost-Effectiveness in HIV Prevention

“…In serodiscordant couples, an estimated ICER for PrEP plus increased ART coverage in Uganda is $5,354/DALY averted [49], and in South Africa a similar intervention – with inclusion of ART initiation among eligible serodiscordant partners – has an ICER of $10,383/DALY averted [50]. A Mozambique-based study examined PrEP for partners of migrant miners; the cost per infection averted was $71,374 for year-long PrEP and was reduced to $9,538 if limited to a six-week high-risk period when the miners return home [51]. …”