scholarly journals Estimating the Cost-Effectiveness of Pre-Exposure Prophylaxis to Reduce HIV-1 and HSV-2 Incidence in HIV-Serodiscordant Couples in South Africa

PLoS ONE ◽  
2015 ◽  
Vol 10 (1) ◽  
pp. e0115511 ◽  
Author(s):  
Britta L. Jewell ◽  
Ide Cremin ◽  
Michael Pickles ◽  
Connie Celum ◽  
Jared M. Baeten ◽  
...  
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Serodiscordant Couples ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Hiv 1

scholarly journals Evaluating the Cost-Effectiveness of Pre-Exposure Prophylaxis (PrEP) and Its Impact on HIV-1 Transmission in South Africa

PLoS ONE ◽  
2010 ◽  
Vol 5 (11) ◽  
pp. e13646 ◽  
Author(s):  
Carel Pretorius ◽  
John Stover ◽  
Lori Bollinger ◽  
Nicolas Bacaër ◽  
Brian Williams
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
Hiv 1

scholarly journals 992. Rethinking the 28-day HIV nPEP Dispensing Practice: A Pediatric ID Clinic Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
David Zhang ◽  
Julia Rosebush ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Veena Ramaiah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Wholesale Price ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Post Exposure Prophylaxis ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
The University ◽  
Lost To Follow Up

Abstract Background In July 2017, The University of Chicago Comer Children’s Hospital Emergency Department (ED) transitioned from a 5-day to a 28-day HIV nPEP (non-occupational post-exposure prophylaxis) dispensation model in an effort to increase adherence. Anecdotal reports of patients lost to follow-up after ED discharge called into question the utility and cost-effectiveness of this practice. We analyzed HIV nPEP follow-up rates in our clinic, explored reasons for nonadherence, and performed basic cost-savings analyses to inform potential changes to our dispensation model. Methods A retrospective review of both electronic health and pharmacy records was conducted for patients prescribed 28-days of HIV nPEP in the ED and scheduled for outpatient follow-up in Pediatric ID clinic from July 2017-June 2019. Clinic provider documentation of nPEP adherence and reasons for nonadherence were examined. Patients were given an initial dose of nPEP regimen in the ED and provided all subsequent doses to complete at home. Using average wholesale price (AWP), we calculated the total cost of each regimen and potential savings if a shorter duration of HIV nPEP supply was dispensed. Results 50 patients received a 28-day supply of HIV nPEP. Please refer to Table 1 regarding baseline patient characteristics. Of these, only 19 (38%) patients had documented outpatient follow-up after nPEP initiation. Median time to follow-up was 6 days (IQR: 3.0-9.0 days). Of the 19 patients with follow-up, 3 admitted to medication non-adherence. Although side effects were elicited in a total of 9 patients (18%), only 1 cited medication intolerance as the reason for discontinuing their nPEP. Given the relatively short time to follow-up, a potential savings of $1720-2211/patient could be achieved if a 10-14 day supply was dispensed. Conclusion Outpatient follow-up after 28-day HIV nPEP dispensation in our ED was < 40%, calling into question the cost-effectiveness of this dispensation model. While our current practice alleviates nPEP interruption due to potential insurance issues and pick-up delays, follow-up and adherence are not assured. The significant cost-savings with a shorter supply at the outset may encourage more robust follow-up and adherence. Disclosures All Authors: No reported disclosures

scholarly journals Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

2018 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Renee Heffron ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Nulu Bulya ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Hiv Treatment ◽  
Demonstration Project ◽  
Hiv Incidence ◽  
Serodiscordant Couples ◽  
Treatment Services ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk.  Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART).  We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP.  Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected.  Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services.   Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV.  Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

Evaluating the cost-effectiveness of invasive alien plant clearing: A case study from South Africa

2012 ◽  
Vol 155 ◽  
pp. 128-135 ◽  
Author(s):  
Matthew M. McConnachie ◽  
Richard M. Cowling ◽  
Brian W. van Wilgen ◽  
Dominic A. McConnachie
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Alien Plant ◽  
Invasive Alien Plant ◽  
The Cost

scholarly journals Whatʼs Love Got to Do With It? Explaining Adherence to Oral Antiretroviral Pre-Exposure Prophylaxis for HIV-Serodiscordant Couples

2012 ◽  
Vol 59 (5) ◽  
pp. 463-468 ◽  
Author(s):  
Norma C. Ware ◽  
Monique A. Wyatt ◽  
Jessica E. Haberer ◽  
Jared M. Baeten ◽  
Alexander Kintu ◽  
...  
Keyword(s):  
Serodiscordant Couples ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis

scholarly journals Cost-effectiveness and community impacts of two urine-collection programs in rural South Africa

2016 ◽  
Vol 2 (2) ◽  
pp. 320-335 ◽  
Author(s):  
Elizabeth Tilley
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Urine Collection ◽  
Rural South ◽  
Community Impacts ◽  
The Cost ◽  
Collection Programs ◽  
Rural South Africa

The cost-effectiveness of two different urine-collection programs in South Africa are modelled over a range of parameters and are interpreted from the perspective of both the municipality and the community.

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