Epidemiological impact of tenofovir gel on the HIV epidemic in South Africa
Journal of Acquired Immune Deficiency Syndromes
South African Centre for Epidemiological Modelling and Analysis (SACEMA), 19 Jonkershoek Road, Stellenbosch, South Africa; South Africa and Department of Epidemiology, University of KwaZulu-Natal, Columbia University, NY, United States; Strategic Intelligence and Analysis Division, UNAIDS-Joint United Nations Program on HIV/AIDS, Geneva, Switzerland
Background: Tenofovir gel, an antiretroviral-based vaginal microbicide, reduced HIV acquisition by 39% in women in a recent randomized controlled clinical trial in South Africa. Methods: To inform policy, we used a dynamical model of HIV transmission, calibrated to the epidemic in South Africa, to determine the population-level impact of this microbicide on HIV incidence, prevalence, and deaths and to evaluate its cost-effectiveness. Results: If women use tenofovir gel in 80% or more of sexual encounters (high coverage), it could avert 2.33 (0.12 to 4.63) million new infections and save 1.30 (0.07 to 2.42) million lives and if used in 25% of sexual encounters (low coverage), it could avert 0.50 (0.04 to 0.77) million new infections and save 0.29 (0.02 to 0.44) million deaths, over the next 20 years. At US $0.50 per application, the cost per infection averted at low coverage is US $2392 (US $562 to US $4222) and the cost per disability-adjusted life year saved is US $104 (US $27 to US $181); at high coverage the costs are about 30% less. Conclusions: Over 20 years, the use of tenofovir gel in South Africa could avert up to 2 million new infections and 1 million AIDS deaths. Even with low rates of gel use, it is highly cost-effective and compares favorably with other control methods. This female-controlled prevention method could have a significant impact on the epidemic of HIV in South Africa. Programs should aim to achieve gel use in more than 25% of sexual encounters to significantly alter the course of the epidemic. © 2011 by Lippincott Williams & Wilkins.
microbicide; tenofovir; acquired immune deficiency syndrome; article; cost effectiveness analysis; disability; epidemic; female; gel; health care cost; human; Human immunodeficiency virus infection; incidence; mortality; prevalence; priority journal; sexual intercourse; South Africa; virus transmission; Adenine; Anti-HIV Agents; Cost-Benefit Analysis; Female; HIV Infections; Humans; Incidence; Models, Biological; Phosphonic Acids; Prevalence; South Africa; Vaginal Creams, Foams, and Jellies