{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T06:11:10Z","timestamp":1781417470569,"version":"3.54.1"},"reference-count":67,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084416"],"award-info":[{"award-number":["OPP1084416"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID\u2010674\u2010A\u201012\u201000034"],"award-info":[{"award-number":["AID\u2010674\u2010A\u201012\u201000034"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["214204\/A\/18\/Z"],"award-info":[{"award-number":["214204\/A\/18\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In 2016, South Africa (SA) initiated a national programme to scale\u2010up pre\u2010exposure prophylaxis (PrEP) among female sex workers (FSWs), with \u223c20,000 PrEP initiations among FSWs (\u223c14% of FSW) by 2020. We evaluated the impact and cost\u2010effectiveness of this programme, including future scale\u2010up scenarios and the potential detrimental impact of the COVID\u201019 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A compartmental HIV transmission model for SA was adapted to include PrEP. Using estimates on self\u2010reported PrEP adherence from a national study of FSW (67.7%) and the Treatment and Prevention for FSWs (TAPS) PrEP demonstration study in SA (80.8%), we down\u2010adjusted TAPS estimates for the proportion of FSWs with detectable drug levels (adjusted range: 38.0\u201370.4%). The model stratified FSW by low (undetectable drug; 0% efficacy) and high adherence (detectable drug; 79.9%; 95% CI: 67.2\u201387.6% efficacy). FSWs can transition between adherence levels, with lower loss\u2010to\u2010follow\u2010up among highly adherent FSWs (aHR: 0.58; 95% CI: 0.40\u20130.85; TAPS data). The model was calibrated to monthly data on the national scale\u2010up of PrEP among FSWs over 2016\u20132020, including reductions in PrEP initiations during 2020. The model projected the impact of the current programme (2016\u20132020) and the future impact (2021\u20132040) at current coverage or if initiation and\/or retention are doubled. Using published cost data, we assessed the cost\u2010effectiveness (healthcare provider perspective; 3% discount rate; time horizon 2016\u20132040) of the current PrEP provision.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Calibrated to national data, model projections suggest that 2.1% of HIV\u2010negative FSWs were currently on PrEP in 2020, with PrEP preventing 0.45% (95% credibility interval, 0.35\u20130.57%) of HIV infections among FSWs over 2016\u20132020 or 605 (444\u2013840) infections overall. Reductions in PrEP initiations in 2020 possibly reduced infections averted by 18.57% (13.99\u201323.29). PrEP is cost\u2010saving, with $1.42 (1.03\u20131.99) of ART costs saved per dollar spent on PrEP. Going forward, existing coverage of PrEP will avert 5,635 (3,572\u20139,036) infections by 2040. However, if PrEP initiation and retention doubles, then PrEP coverage increases to 9.9% (8.7\u201311.6%) and impact increases 4.3 times with 24,114 (15,308\u201338,107) infections averted by 2040.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings advocate for the expansion of PrEP to FSWs throughout SA to maximize its impact. This should include strategies to optimize retention and should target women in contact with FSW services.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26063","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T08:47:54Z","timestamp":1676882874000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact and cost\u2010effectiveness of the national scale\u2010up of HIV pre\u2010exposure prophylaxis among female sex workers in South Africa: a modelling analysis"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4584-0068","authenticated-orcid":false,"given":"Jack","family":"Stone","sequence":"first","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-4562","authenticated-orcid":false,"given":"Rutendo","family":"Bothma","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela B.","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Eakle","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand  Johannesburg South Africa"},{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"},{"name":"Office of HIV AIDS U.S. Agency for International Development (USAID)  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christinah","family":"Mukandavire","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"},{"name":"Department of Infectious Disease Epidemiology Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasina","family":"Subedar","sequence":"additional","affiliation":[{"name":"National Department of Health  Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4340-9995","authenticated-orcid":false,"given":"Hannah","family":"Fraser","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie\u2010Claude","family":"Boily","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheree","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Coetzee","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"South African Medical Research Council  Cape Town South Africa"},{"name":"African Potential Management Consultancy  Kyalami South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kennedy","family":"Otwombe","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"School of Public Health Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4654-8755","authenticated-orcid":false,"given":"Minja","family":"Milovanovic","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"},{"name":"African Potential Management Consultancy  Kyalami South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5482-2419","authenticated-orcid":false,"given":"Stefan","family":"Baral","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2717-011X","authenticated-orcid":false,"given":"Leigh F.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem Daniel Francois","family":"Venter","sequence":"additional","affiliation":[{"name":"Ezintsha Faculty of Health Sciences University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Rees","sequence":"additional","affiliation":[{"name":"Wits RHI University of the Witwatersrand  Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8291-5890","authenticated-orcid":false,"given":"Peter","family":"Vickerman","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"SAHMS\u2010FSW.South African Health Monitoring Survey (SAHMS): an integrated biological and behavioural survey among female sex workers South Africa 2013\u20132014.2014."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0184775"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001471"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002444"},{"key":"e_1_2_12_6_1","unstructured":"South African National AIDS Council.National strategic plan for HIV prevention care and treatment for sex workers.Pretoria South Africa;2013."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011595"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0265434"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25390"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000002535"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25650"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010682"},{"key":"e_1_2_12_13_1","unstructured":"MilovanovicM JafferM MbowaneV HlongwaneK OtwombeK BuckleyJ et\u00a0al.Male clients of female sex workers in South Africa: sexual risk behaviour and violence.The 9th SA AIDS Conference.Durban;2019."},{"key":"e_1_2_12_14_1","unstructured":"Human Sciences Research Council.South African National HIV Prevalence HIV Incidence Behaviour and Communication Survey (SABSSM) 2005: adult and youth data \u2010 all provinces. [Data set]. SABSSM 2005 Adult\u2010youth. Version 1.0. Pretoria South Africa: Human Sciences Research Council [producer] 2005 Human Sciences Research Council [distributor];2011."},{"key":"e_1_2_12_15_1","unstructured":"Human Sciences Research Council.South African HIV\/AIDS Behavioural Risks Sero\u2010status and Mass Media Impact Survey (SABSSM) 2002: adult and youth data \u2010 all provinces. [Data set]. SABSSM 2002 Adult\u2010youth. Version 1.0. Pretoria South Africa: Human Sciences Research Council [producer] 2002 Human Sciences Research Council [distributor];2011."},{"key":"e_1_2_12_16_1","unstructured":"Human Sciences Research Council.South African National HIV Prevalence HIV Incidence Behaviour and Communication Survey (SABSSM) 2012: adult \u2010 all provinces. [Data set]. SABSSM 2012 Adult. Version 1.0. Pretoria South Africa: Human Sciences Research Council [producer] 2012 Human Sciences Research Council [distributor];2016."},{"key":"e_1_2_12_17_1","unstructured":"Human Sciences Research Council.South African National HIV Prevalence HIV Incidence Behaviour and Communication Survey (SABSSM) 2017: Combined \u2013 All provinces. [Data set]. SABSSM 2017 Combined. Version 1.0. Pretoria South Africa: Human Sciences Research Council [producer] 2017 Human Sciences Research Council [distributor]2020.https:\/\/doi.org\/10.14749\/1585345902"},{"key":"e_1_2_12_18_1","unstructured":"Human Sciences Research Council.South African National HIV Prevalence HIV Incidence Behaviour and Communication Survey (SABSSM) 2008: adult \u2010 all provinces. [Data set]. SABSSM 2008 Adult. Version 1.0. Pretoria South Africa: Human Sciences Research Council [producer] 2009 Human Sciences Research Council [distributor];2014."},{"key":"e_1_2_12_19_1","unstructured":"SWPSSES.Estimating the size of the sex worker population in South Africa 2013. Sex worker population size estimate study (SWPSES).2013."},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2008.0172"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000172"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.2591"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1402269"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30359-3"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002943"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-020-03140-5"},{"key":"e_1_2_12_28_1","doi-asserted-by":"crossref","unstructured":"TohWQ TreibichC SzawlowskiS CustH MbayeEHA GueyeK et\u00a0al.Impact of COVID\u201019 on female sex workers in Africa: evidence from a cohort study in Senegal. Available at SSRNhttps:\/\/ssrn.com\/abstract=3710613orhttps:\/\/doi.org\/10.2139\/ssrn.3710613","DOI":"10.2139\/ssrn.3710613"},{"key":"e_1_2_12_29_1","unstructured":"https:\/\/www.gov.za\/covid\u201019\/about\/about\u2010alert\u2010system. [Cited 2022 May 11]."},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228620"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-000964"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002486"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0210497"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00069-8"},{"key":"e_1_2_12_35_1","unstructured":"Bill Melinda Gates Foundation Methods for Economic Evaluation Project.The Gates reference case: what it is why it's important and how to use it.Seattle:Bill and Melinda Gates Foundation;2014."},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_2_12_37_1","unstructured":"Cabotegravir: what are we waiting for? M\u00e9decins Sans Fronti\u00e8res Access Campaign [Internet]. [Cited 2022 Nov 8]. Available from:https:\/\/msfaccess.org\/cabotegravir\u2010what\u2010are\u2010we\u2010waiting."},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00025-5"},{"key":"e_1_2_12_39_1","unstructured":"UNAIDS\u2010AIDSinfo. Available fromhttp:\/\/aidsinfo.unaids.org\/. Accessed 15 Nov 2022."},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000412"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000433237.63560.20"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.4211"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25064"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz667"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25282"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000001253"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60974-0"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v9.30314"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21744"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0218710"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25064"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(17)30021-8"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25451"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz1229"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003492"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(17)30181-9"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30003-5"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(18)30215-7"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002680"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-019-02733-z"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2020.61.5.349"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25081"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X17729376"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001945"},{"key":"e_1_2_12_65_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25442"},{"key":"e_1_2_12_66_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-019-0716-7"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0188606"},{"key":"e_1_2_12_68_1","unstructured":"PEFSW. Female sex workers in Port Elizabeth.2015."}],"updated-by":[{"DOI":"10.1002\/jia2.26082","type":"erratum","label":"Erratum","source":"publisher","updated":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T00:00:00Z","timestamp":1681689600000}}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26063","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.26063","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T23:55:11Z","timestamp":1692402911000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2]]},"references-count":67,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1002\/jia2.26063"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26063","archive":["Portico"],"relation":{"erratum":[{"id-type":"doi","id":"10.1002\/jia2.26082","asserted-by":"object"}]},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2]]},"assertion":[{"value":"2022-05-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26063"}}