{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:49:32Z","timestamp":1786978172118,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T00:00:00Z","timestamp":1576713600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Although pre\u2010exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub\u2010Saharan Africa, likely due to non\u2010adherence. Adherence may be improved with the use of injectable long\u2010acting PrEP methods currently being developed. We hypothesize that providing long\u2010acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to PrEP, result in a reduction of new HIV infections, and be a relatively easy\u2010to\u2010reach target population. In this modelling study, we assessed the epidemiological impact and cost\u2010effectiveness of providing long\u2010acting PrEP to injectable contraceptive users in Limpopo, South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a deterministic mathematical model calibrated to the HIV epidemic in Limpopo. Long\u2010acting PrEP was provided to 50% of HIV negative injectable contraceptive users in 2018 and scaled\u2010up over two years. We estimated the number of HIV infections that could be averted by 2030 and the drug price of long\u2010acting PrEP for which this intervention would be cost\u2010effective over a time horizon of 40\u00a0years, from a healthcare payer perspective. In the base\u2010case scenario we assumed long\u2010acting PrEP is 75% effective in preventing HIV infections and 85% of infected individuals are on antiretroviral drug therapy (ART) by 2030. In sensitivity analyses we adjusted PrEP effectiveness and ART coverage. Costs between $519 and $1119 per disability\u2010adjusted life\u2010year (DALY) averted were considered potentially cost\u2010effective, and &lt;$519 as cost\u2010effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Without long\u2010acting injectable PrEP, 224,000 (interquartile range 176,000 to 271,000) new infections will occur by 2030; use of long\u2010acting injectable PrEP could prevent 21,000 (17,000 to 26,000) or 9.8% (8.9% to 10.6%) new HIV infections by 2030 (including 6000 (4000 to 7000) in men). Long\u2010acting PrEP would prevent 34,000 (29,000 to 39,000) or 12,000 (8000 to 15,000) at 75% and 95% ART coverage by 2030 respectively. To be considered potentially cost\u2010effective the annual long\u2010acting PrEP drug price should be &lt;$16, and\/or ART coverage remains at &lt;85% in 2030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Providing long\u2010acting PrEP to injectable contraceptive users in Limpopo is only potentially cost\u2010effective when long\u2010acting PrEP drug prices are low. If low prices are not feasible, providing long\u2010acting PrEP only to women at high risk of HIV infection will become important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25427","type":"journal-article","created":{"date-parts":[[2019,12,19]],"date-time":"2019-12-19T11:10:45Z","timestamp":1576753845000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Epidemiological impact and cost\u2010effectiveness of providing long\u2010acting pre\u2010exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5476-037X","authenticated-orcid":false,"given":"Marjolein M","family":"van Vliet","sequence":"first","affiliation":[{"name":"Department of Viroscience Erasmus MC Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2744-5208","authenticated-orcid":false,"given":"Cheryl","family":"Hendrickson","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-4999","authenticated-orcid":false,"given":"Brooke E","family":"Nichols","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"Department of Global Health Boston University School of Public Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0892-5473","authenticated-orcid":false,"given":"Charles AB","family":"Boucher","sequence":"additional","affiliation":[{"name":"Department of Viroscience Erasmus MC Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2124-7275","authenticated-orcid":false,"given":"Remco PH","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology School of Public Health &amp; Primary Care (CAPHRI) Maastricht University Medical Centre Maastricht The Netherlands"},{"name":"Anova Health Institute Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-8526","authenticated-orcid":false,"given":"David AMC","family":"van de Vijver","sequence":"additional","affiliation":[{"name":"Department of Viroscience Erasmus MC Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,19]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"South African National HIV prevalence, incidence and behaviour survey, 2012","author":"Shisana O","year":"2014"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1917"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402269"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-017-0353-0"},{"key":"e_1_2_9_7_1","unstructured":"National institute of Allergy and Infectious Diseases.NIH launches first large trial of a long\u2010acting injectable drug for HIV prevention[cited 2016 Oct 18].2017. Available from:https:\/\/www.niaid.nih.gov\/news-events\/nih-launches-first-large-trial-long-acting-injectable-drug-hiv-prevention"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0028238"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X17729376"},{"key":"e_1_2_9_10_1","unstructured":"Network HHPT.HPTN 076 phase II safety and acceptability of an investigational injectable product TMC278 LA For Pre Exposure prophylaxis (PrEP).2017[cited 2018 Apr 24]. Available from:https:\/\/www.hptn.org\/research\/studies\/hptn076#block-views-block-study-detail-block-block-2-3"},{"key":"e_1_2_9_11_1","volume-title":"South Africa Demographic and Health Survey 2016","author":"National Department of Health (NDoH)","year":"2019"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001228"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31288-7"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X17729376"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.4102\/sajhivmed.v18i1.694"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1248707"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3010298"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3010297"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1086\/590501"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000066"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3281532c82"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir494"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0210497"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/for.3980100108"},{"key":"e_1_2_9_25_1","unstructured":"Mid\u2010year population estimates 2017 in statistical release P0302.Pretoria South Africa:Statistics South Africa 2017."},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2016.02.017"},{"key":"e_1_2_9_27_1","volume-title":"Guideline on when to start antiretroviral therapy and on pre\u2010exposure prophylaxis for HIV","author":"WHO","year":"2015"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001794"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1627-z"},{"key":"e_1_2_9_30_1","unstructured":"MillsLA KwaroD OdongoF OgindoP OtienoF SsempijjaV et al.Acceptability of novel ARV\u2010based HIV prevention methods in a rural Kenyan health and demographic surveillance community. 19th international AIDS conference.Washington DC;2012."},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001392"},{"key":"e_1_2_9_32_1","unstructured":"PEPFAR.Statement on potential safety issue affecting women living with hiv using dolutegravir at the time of conception. [cited 2018 Jun 26].2018. Available from:https:\/\/www.pepfar.gov\/press\/releases\/282221.htm"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000433237.63560.20"},{"key":"e_1_2_9_34_1","unstructured":"CairnsG.The \u2018long tail\u2019 problem: injected\u2010PrEP trial will be extended due to persistence of drug in companion study. November 11 2016[cited 2018 June 28]. Available from:http:\/\/www.aidsmap.com\/The-long-tail-problem-injected-PrEP-trial-will-be-extended-due-to-persistence-of-drug-in-companion-study\/page\/3098285\/"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0000875"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835ca2dd"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw321"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0059549"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-12-46"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000145"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0013646"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiv523"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25064"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjia2.25427","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25427","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25427","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25427","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:55:37Z","timestamp":1694134537000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":42,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1002\/jia2.25427"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25427","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"2019-05-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-12-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25427"}}