Table 1.
List of interventions and coverage levels included in the optimisation routine
| Intervention | Description | Coverage level | |||||||
|---|---|---|---|---|---|---|---|---|---|
| −2 | −1 | BL | +1 | +2 | +3 | FM (2018/19) | |||
| Antiretroviral therapy (ART) under current guidelines | Increase ART coverage while maintaining current eligibility criteria (CD4 < 500 and PMTCT B+ (triple ART initiation for life in all pregnant women)) | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% |
| Universal treatment | Changing guidelines to allow for universal treatment (regardless of CD4 count) in addition to increasing ART coverage | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 95% |
| Adult medical male circumcision (MMC) | Only unmarried men are assumed to get circumcised as a result of programmes that promote MMC as an HIV prevention strategy | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 550,000 circumcisions (model maximum) |
| Early infant male circumcision (EIMC)a | Circumcision of male infants in their first year of life | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 70% |
| Condom availability | This refers to distributing sufficient condoms to ensure that a specified proportion of sex acts (~24%) will be protected | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% |
| PrEP for female sex workers | Providing PrEP to sex workers only | - | - | - | ✓ | ✓ | ✓ | ✓ | 70% |
| PrEP for young women | Providing PrEP to young women aged 15–24 only | - | - | - | ✓ | ✓ | ✓ | ✓ | 70% |
| Prevention of mother to child transmission (PMTCT) | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% | |
| Infant testing at birth | ART uptake in pregnant women | - | - | - | ✓ | ✓ | ✓ | ✓ | 70% |
| Infant testing at 6 weeks | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% | |
| HIV counselling and testing (HCT) of general population | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 18,153,000 tests (personal communication, NDoH) | |
| HCT of sex workers | - | - | - | ✓ | ✓ | ✓ | ✓ | 95% | |
| HCT of adolescents | Dedicated HIV testing drives targeted at sex workers | - | - | - | ✓ | ✓ | ✓ | ✓ | 95% |
| Social and behaviour change (SBCC) mass media campaign 1b | Dedicated HIV testing drives targeted at adolescents | - | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% |
| SBCC mass media campaign 2 | Message of reducing multiple sexual partners and increasing testing in adolescents | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% |
| SBCC mass media campaign 3 | Message of increasing condom usage and self-efficacy | ✓ | ✓ | - | ✓ | ✓ | ✓ | ✓ | 95% |
aAlthough a novel intervention, the model assumed a non-zero baseline for EIMC [31]. We therefore retained the B-1 and B-2 coverage level scenarios in our analysis
bSince a number of organisations responsible for SBCC campaigns were involved in a government tender submission process at the time of analysis, we anonymised the campaigns in order to not unduly influence the tender process