3/4/2023 0 Comments The bridge barnabas healthPrimary prevention strategies to prevent HIV acquisition are also needed particularly among high-risk persons. Expanding ART coverage may not be straightforward if asymptomatic persons with higher CD4 counts do not initiate ART and achieve durable viral suppression. Thus, current coverage provides modest population-level reduction in HIV transmission. However, despite the progress in treatment coverage, an additional 15 million HIV-positive persons who are eligible for ART have yet to start. Furthermore, ecologic data from Kwa Zulu-Natal indicate that ART is associated with substantial decreases in HIV incidence with a 38% (95% CI: 24–50%) reduction in HIV incidence associated with 30–40% ART coverage relative to <10% ART coverage. The increased coverage has led to significant health gains, such as an (95% confidence interval (CI): 9.6 to 12.9 years) increase in life expectancy by 11.3 years in KwaZulu-Natal, South Africa, from 2003 to 2011. The incremental cost-effectiveness ratios (ICERs) per HIV infection and disability-adjusted life year (DALY) averted were calculated over 10 years.Īntiretroviral therapy (ART) to treat HIV-positive persons has expanded to almost 10 million patients in low- and middle-income countries in 2013. We parameterized an HIV transmission model to estimate the health and economic impacts of 1) PrEP and ART targeted to high-risk serodiscordant couples in the context of current ART use and 2) increasing ART coverage to 55% of HIV-positive persons with CD4 ≤500 cells/µL without PrEP. Using Ministry of Health costs, the cost of PrEP and ART provision within a government programme was estimated, as was the cost of providing PrEP in addition to ART. The cost (in USD, in 2012) of PrEP and ART for serodiscordant couples was assessed, with and without research components, in the study setting. To estimate the real world delivery costs of PrEP, we conducted micro-costing and time and motion analyses in an open-label prospective study of PrEP and ART delivery targeted to high-risk serodiscordant couples in Uganda (the Partners Demonstration Project).
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