Table 6. Health outcomes and cost-effectiveness of combination HIV prevention interventions.
HIV infection (over 10 years) (%) | Incremental | |||||||
---|---|---|---|---|---|---|---|---|
Incidence | Infections averted | Deaths | QALYS | Cost | CER | |||
Status quo | 5.44 | - | 0.43 | 12.53 | 6467.96 | - | ||
Scenario | Combinations | ART | ||||||
VMMC | Upscale | 2.56 | 52.49 | 0.31 | + 13.13 | + 361.10 | 27.50 | |
VMMC + HIV vaccine | Current | 3.46 | 36.39 | 0.28 | + 18.24 | + 206.52 | 11.32 | |
Upscale | 2.25 | 58.71 | 0.27 | + 18.87 | + 581.11 | 30.80 | ||
VMMC + PrEP | Current | 3.24 | 40.35 | 0.27 | + 30.78 | + 2 062.08 | 67.00 | |
Upscale | 2.11 | 61.28 | 0.26 | + 31.42 | + 2 433.94 | 77.46 | ||
HIV vaccine + PrEP | Current | 3.15 | 41.99 | 0.26 | + 19.02 | + 2 188.01 | 115.08 | |
Upscale | 2.06 | 62.11 | 0.25 | +19.65 | + 2 563.53 | 130.42 | ||
Dual + VMMC | Current | 3.04 | 44.11 | 0.24 | + 42.68 | Dominant | Dominant |
Combined interventions are compared with the status quo (i.e. continuing to treat HIV infection with ART at 29% coverage (1))
ART: Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; HPV: Human Papillomavirus; Dual Vaccine: HIV and HPV Vaccinations; VMMC: Voluntary Male Medical Circumcision; Prep: Pre-Exposure Prophylaxis
(ART scale-up covers the ART deficit of 58%; HIV and HPV vaccine quoted at 50% and 70% vaccine efficacy respectively; VMMC efficacy is 60%, PrEP efficacy is 67% (Range = 21% - 67%); all coverage =60%.)