Table 1.
Key Intervention-Related Parameters
| Parameter | Base-Case Value Optimistic, Conservative | LHS Range | Source |
|---|---|---|---|
| MMC | |||
| Target coverage among sexually active men, % | 80 | 23–80 | [2, 16] |
| Effectiveness against male HIV acquisition, % | 60 | 60 | [18] |
| ART | |||
| ART coverage of CD4 ≤500 cells/µL at 2020, % | 80 | 65–80 | [16, 17] |
| ART effectiveness against HIV transmission while suppressed, % | 96 | 73–99 | [3] |
| PrEP | |||
| Year PrEP scale-up begins | 2015 | 2015–2020 | Assumed |
| Time to reach target coverage, y | 5 | 2.5–7.5 | Assumed |
| Intended duration of personal use, y | 5 | 2.5–7.5 | Assumed |
| Proportion who drop out of early, % | 40 | 5–60 | [19] |
| Injection frequency, per year | 6 | 6 | [19] |
| HIV testing frequency in the PrEP program, per year | 2 | 1–6 | Assumed |
| Reliability (proportion of injections that are efficacious), % | 80, 70 | 50–99 | Assumed |
| Efficacy | |||
| Efficacy against wild-type HIV or ART-resistant HIV without PrEP cross-resistance, % | 90, 70 | 50–99 | [8, 9] |
| Efficacy against ART-resistant HIV with PrEP cross-resistance (≥10-fold change in RPV IC90), % | 0 | 0 | [20] |
| Efficacy against ART-resistant HIV with PrEP cross-resistance (3- to 9-fold change in RPV IC90), % | 45, 35 | 0–50 | [20] |
| Efficacy against PrEP-resistant HIV, % | 22.5, 0 | 0–50 | Assumed |
| Time until resistance emergence in a cohort on PrEP | |||
| Time until emergence if breakthrough infection occurs after a successful injection, wk | 4 | 2–6 | [21] |
| Rate resistance emerges if breakthrough occurs after a nonsuccessful injection, relative to after successful injection, % | 0, 100 | 0–100 | Assumed |
| Cost | |||
| PrEP costs (drug costs plus diagnostics and overhead), $ per person-year | 250 | 150–350 | [22] |
| MMC cost, per surgery | 110 | 70–150 | [23] |
| ART costs (drug costs plus diagnostics and overhead), $ per person-year | 750 | 460–1040 | [24] |
Additional ART-related inputs and cost parameters are given in Supplementary Table 3.
Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus; IC90, inhibitory concentration required to reduce virus replication 90%; LHS, Latin hypercube sampling; MMC, male medical circumcision; PrEP, preexposure prophylaxis; RPV, rilpivirine.