UNASSIGNED:口服暴露前预防(PrEP)和抗逆转录病毒疗法(ART)可以有效预防男男性行为者(MSM)中的HIV感染,但HIV耐药性(HIVDR)的出现和传播可能会损害其益处.在中国存在HIVDR的情况下扩大PrEP和ART覆盖范围的成本和收益仍然未知。
UNASSIGNED:我们开发了一种综合的动态传播模型,该模型结合了传播(TDR)和获得性(ADR)HIV耐药性。利用2009-2019年江苏省MSM人群HIV监测数据对模型进行校正,中国,并通过ADR和TDR的动态流行进行验证。我们的目的是调查八种干预方案的影响(无PrEP,20%,50%或80%的PrEP,在接下来的30年中,没有(77%的覆盖率)或(90%的覆盖率)扩大ART的HIV流行趋势和PrEP的成本效益。
未经批准:20%或50%的PrEP+90%的ART具有成本效益,增量成本效益比(ICER)为25,417(95%置信区间[CI]:12,390-38,445)或47,243(23,756-70,729),在未来30年内,将产生154,949(89,662-220,237)或179,456(102,570-256,342)增量质量调整寿命年(QALY)。没有PrEP+90%ART会产生125,211(73,448-176,974)个增量QALYs,并且节省成本。然而,20-80%PrEP+77%ART和80%PrEP+90%ART,ICER分别为$77,862-$98,338和$63,332,而且不划算。口服PrEP的年度成本降低64%将使其对50%PrEP+90%ART具有很高的成本效益。
未经批准:20%或50%PrEP+90%ART在HIVDR存在的情况下控制HIV具有成本效益。在当前有限的预算下,单独扩展ART可能是最佳策略。
联合国:国家自然科学基金委员会,国家科技重大项目基金会.
UNASSIGNED: Oral pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) can effectively prevent HIV infections among men who have sex with men (MSM), but the emergence and transmission of HIV drug-resistance (HIVDR) may compromise their benefits. The costs and benefits of expanding PrEP and ART coverage in the presence of HIVDR in China remain unknown.
UNASSIGNED: We developed a comprehensive dynamic transmission model incorporating the transmitted (TDR) and acquired (ADR) HIV drug resistance. The model was calibrated by the HIV surveillance data from 2009 to 2019 among MSM in Jiangsu Province, China, and validated by the dynamic prevalence of ADR and TDR. We aimed to investigate the impact of eight intervention scenarios (no PrEP, 20%, 50% or 80% of PrEP, without (77% coverage) or with (90% coverage) expanded ART) on the HIV epidemic trend and cost-effectiveness of PrEP over the next 30 years.
UNASSIGNED: 20% or 50% PrEP + 90% ART would be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 25,417 (95% confidence interval [CI]: 12,390-38,445) or 47,243 (23,756-70,729), and would yield 154,949 (89,662-220,237) or 179,456 (102,570-256,342) incremental quality-adjusted life-years (QALYs) over the next 30 years. No PrEP + 90% ART would yield 125,211 (73,448-176,974) incremental QALYs and be cost-saving. However, 20-80% PrEP + 77% ART and 80% PrEP + 90% ART with ICER of $77,862-$98,338 and $63,332, respectively, and were not cost-effective. A reduction of 64% in the annual cost of oral PrEP would make it highly cost-effective for 50% PrEP + 90% ART.
UNASSIGNED: 20% or 50% PrEP + 90% ART is cost-effective for HIV control in the presence of HIVDR. Expanded ART alone may be the optimal policy under the current limited budgets.
UNASSIGNED: National Natural Science Foundation of China, the National S&T Major Project Foundation of China.