Table 1.
Assessment of modelling evidence to inform strategies of PrEP implementation in sub‐Saharan Africa
| PrEP strategies in sub‐Saharan Africa | Current | CEA compliance | Study agreement | Rigour | Traffic light assessment | Evidence for CE (0.5 × GDP) |
|---|---|---|---|---|---|---|
| PrEP for serodiscordant couples | ||||||
| Short‐term PrEP for HIV‐ until HIV+ partner achieves viral suppression (4) | − | − | + | + | Amber | Yes |
| PrEP during conception & pregnancy for HIV‐ women in discordant partnerships (3) | − | − | − | + | Amber | Yes |
| Study‐setting delivery of ART and PrEP programme for high‐risk serodiscordant (2) | + | − | − | + | Amber | No |
| Government delivery of ART and PrEP programme for high‐risk serodiscordant (1) | + | − | − | + | Amber | No |
| PrEP for women | ||||||
| PrEP for all women (7) | − | − | + | + | Amber | Yes |
| PrEP for adolescent girls and young women (9) | − | − | + | + | Amber | Yes |
| Short‐term PrEP for women during periods of high HIV risk (1) | − | − | − | + | Amber | No |
| PrEP for female sex workers (5) | − | − | + | + | Amber | No |
| PrEP for high‐risk female sex workers (1) | + | − | − | + | Amber | No |
| PrEP for “high risk” women (2) | + | − | + | − | Amber | No |
| PrEP for women and universal ART | ||||||
| PrEP for adolescent girls and young women in context of universal ART (2) | + | − | + | + | Amber | No |
| PrEP for women in context of universal ART (1) | + | − | − | + | Amber | No |
| PrEP for female sex workers in context of universal ART (1) | − | − | − | + | Amber | No |
| PrEP for men | ||||||
| PrEP for adolescent boys and young men (3) | − | − | − | + | Amber | No |
| Targeted outreach of MSM for combination prevention including PrEP (2) | − | − | − | + | Amber | No |
| PrEP for high‐risk MSM (1) | − | N/A | − | + | Amber | No |
| PrEP for male sex workers (1) | + | − | − | + | Amber | No |
| PrEP for “high risk” males (2) | + | − | + | − | Amber | No |
| PrEP use in the general population | ||||||
| PrEP for the general population (12) | − | − | + | + | Amber | Yes |
| PrEP for the general population in context of universal ART (1) | + | − | − | + | Amber | Yes |
| PrEP for highly sexually active (6) | − | − | + | + | Amber | Yes |
| PrEP on demand (1) | + | N/A | − | + | Amber | No |
| PrEP for HIV‐ sexual partners of new HIV+ diagnoses, i.e. contact tracing (1) | + | N/A | − | + | Amber | No |
| Resource optimization, combination prevention and PrEP | ||||||
| Optimization of HIV resources and combination prevention in sub‐Saharan Africa (2) | + | − | + | + | Amber | No |
| Optimization of HIV resources and combination prevention in South Africa (2) | − | − | + | + | Amber | No |
| Optimization of HIV resources and combination prevention in Kenya (3) | − | − | + | + | Amber | No |
| Optimization of HIV resources and combination prevention in Zambia (1) | − | − | − | + | Amber | No |
| Optimization of combination prevention for serodiscordant couples (1) | + | − | − | + | Amber | No |
| Optimization of fixed amount of antiretrovirals in the context of 90‐90‐90 & PrEP (1) | + | − | − | − | Amber | No |
| PrEP for populations where HIV incidence is >3 per 100 person‐years (1) | + | − | − | + | Amber | No |
The number of modelling studies pertaining to each strategy is indicated in parentheses. “+” denotes all modelling analyses for a given strategy met the criteria, “−” denotes failure to meet criteria. The criteria assessment criteria are defined as follows: Current: Use of current modelling assumptions and scenarios. CEA compliance: Cost‐effectiveness analyses comply with the Gates Reference Case for economic evaluations 17. Study agreement: The presence of two studies with similar results. Rigour: Modelling analyses comply with criteria adapted from Garnett, et al. 18 recommended for use to evaluate the quality of modelling. Any evidence for cost‐effectiveness at the revised threshold of 0.5 times GDP per capita is denoted in bold for each strategy. ART, antiretroviral treatment; CE, cost‐effectiveness; CEA, cost‐effectiveness analysis; GDP, gross domestic product; HIV, human immunodeficiency virus; MSM, men‐who‐have‐sex‐with‐men; PrEP, pre‐exposure prophylaxis.