{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:33:16Z","timestamp":1768264396710,"version":"3.49.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T00:00:00Z","timestamp":1582848000000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID\u2010OAA\u2010A\u201015\u201000051"],"award-info":[{"award-number":["AID\u2010OAA\u2010A\u201015\u201000051"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID\u2010OAA\u2010A\u201014\u201000060"],"award-info":[{"award-number":["AID\u2010OAA\u2010A\u201014\u201000060"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Oral pre\u2010exposure prophylaxis (PrEP) provision is a priority intervention for high HIV prevalence settings and populations at substantial risk of HIV acquisition. This mathematical modelling analysis estimated the impact, cost and cost\u2010effectiveness of scaling up oral PrEP in 13 countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We projected the impact and cost\u2010effectiveness of oral PrEP between 2018 and 2030 using a combination of the Incidence Patterns Model and the Goals model. We created four PrEP rollout scenarios involving three priority populations\u2014female sex workers (FSWs), serodiscordant couples (SDCs) and adolescent girls and young women (AGYW)\u2014both with and without geographic prioritization. We applied the model to 13 countries (Eswatini, Ethiopia, Haiti, Kenya, Lesotho, Mozambique, Namibia, Nigeria, Tanzania, Uganda, Zambia and Zimbabwe). The base case assumed achievement of the Joint United Nations Programme on HIV\/AIDS 90\u201090\u201090 antiretroviral therapy targets, 90% male circumcision coverage by 2020 and 90% efficacy and adherence levels for oral PrEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the scenarios we examined, oral PrEP averted 3% to 8% of HIV infections across the 13 countries between 2018 and 2030. For all but three countries, more than 50% of the HIV infections averted by oral PrEP in the scenarios we examined could be obtained by rollout to FSWs and SDCs alone. For several countries, expanding oral PrEP to include medium\u2010risk AGYW in all regions greatly increased the impact. The efficiency and impact benefits of geographic prioritization of rollout to AGYW varied across countries. Variations in cost\u2010effectiveness across countries reflected differences in HIV incidence and expected variations in unit cost. For most countries, rolling out oral PrEP to FSWs, SDCs and geographically prioritized AGYW was not projected to have a substantial impact on the supply chain for antiretroviral drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These modelling results can inform prioritization, target\u2010setting and other decisions related to oral PrEP scale\u2010up within combination prevention programmes. We caution against extensive use given limitations in cost data and implementation approaches. This analysis highlights some of the immediate challenges facing countries\u2014for example, trade\u2010offs between overall impact and cost\u2010effectiveness\u2014and emphasizes the need to improve data availability and risk assessment tools to help countries make informed decisions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25451","type":"journal-article","created":{"date-parts":[[2020,2,29]],"date-time":"2020-02-29T04:05:41Z","timestamp":1582949141000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Modelling impact and cost\u2010effectiveness of oral pre\u2010exposure prophylaxis in 13 low\u2010resource countries"],"prefix":"10.1002","volume":"23","author":[{"given":"Carel","family":"Pretorius","sequence":"first","affiliation":[{"name":"Avenir Health Glastonbury CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Schnure","sequence":"additional","affiliation":[{"name":"The Palladium Group Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Dent","sequence":"additional","affiliation":[{"name":"The Palladium Group Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4936-0264","authenticated-orcid":false,"given":"Robert","family":"Glaubius","sequence":"additional","affiliation":[{"name":"Avenir Health Glastonbury CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Mahiane","sequence":"additional","affiliation":[{"name":"Avenir Health Glastonbury CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Avenir Health Takoma Park MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan","family":"Reidy","sequence":"additional","affiliation":[{"name":"Avenir Health Takoma Park MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sindy","family":"Matse","sequence":"additional","affiliation":[{"name":"Ministry of Health Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Njeuhmeli","sequence":"additional","affiliation":[{"name":"United States Agency for International Development (USAID) Mbabane Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Delivette","family":"Castor","sequence":"additional","affiliation":[{"name":"Office of HIV\/AIDS USAID Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8228-4577","authenticated-orcid":false,"given":"Katharine","family":"Kripke","sequence":"additional","affiliation":[{"name":"Avenir Health Takoma Park MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61127-7"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402269"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1110711"},{"key":"e_1_2_10_8_1","unstructured":"WHO.Guideline on when to start antiretroviral therapy and on pre\u2010exposure prophylaxis for HIV.Geneva:WHO;2015[cited 2019 Oct 15]. 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