{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:30:34Z","timestamp":1768516234346,"version":"3.49.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T00:00:00Z","timestamp":1576627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"USAID","doi-asserted-by":"publisher","award":["AID-OAA-A-15-00031"],"award-info":[{"award-number":["AID-OAA-A-15-00031"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009054","name":"PEPFAR","doi-asserted-by":"publisher","award":["AID 674-A-12-00029"],"award-info":[{"award-number":["AID 674-A-12-00029"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009054","name":"PEPFAR","doi-asserted-by":"publisher","award":["72067419CA00004"],"award-info":[{"award-number":["72067419CA00004"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000691","name":"Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Oral preexposure prophylaxis (PrEP) in the form of tenofovir-disoproxil-fumarate\/emtricitabine is being implemented in selected sites in South Africa. Addressing outstanding questions on PrEP cost-effectiveness can inform further implementation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We calibrated an individual-based model to KwaZulu-Natal to predict the impact and cost-effectiveness of PrEP, with use concentrated in periods of condomless sex, accounting for effects on drug resistance. We consider (1) PrEP availability for adolescent girls and young women aged 15\u201324 years and female sex workers, and (2) availability for everyone aged 15\u201364 years. Our primary analysis represents a level of PrEP use hypothesized to be attainable by future PrEP programs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the context of PrEP use in adults aged 15\u201364 years, there was a predicted 33% reduction in incidence and 36% reduction in women aged 15\u201324 years. PrEP was cost-effective, including in a range of sensitivity analyses, although with substantially reduced (cost) effectiveness under a policy of ART initiation with efavirenz- rather than dolutegravir-based regimens due to PrEP undermining ART effectiveness by increasing HIV drug resistance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>PrEP use concentrated during time periods of condomless sex has the potential to substantively impact HIV incidence and be cost-effective.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiz667","type":"journal-article","created":{"date-parts":[[2019,12,17]],"date-time":"2019-12-17T12:10:11Z","timestamp":1576584611000},"page":"1345-1355","source":"Crossref","is-referenced-by-count":32,"title":["Potential Impact and Cost-Effectiveness of Condomless-Sex\u2013Concentrated PrEP in KwaZulu-Natal Accounting for Drug Resistance"],"prefix":"10.1093","volume":"223","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2384-4807","authenticated-orcid":false,"given":"Andrew N","family":"Phillips","sequence":"first","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Cambiano","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leigh","family":"Johnson","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumiyo","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rick","family":"Homan","sequence":"additional","affiliation":[{"name":"FHI 360, Durham, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gesine","family":"Meyer-Rath","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Health Economics and Epidemiology Research Office, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa"},{"name":"Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Rehle","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Tanser","sequence":"additional","affiliation":[{"name":"Lincoln Institute for Health, University of Lincoln, Lincoln, UK"},{"name":"Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa"},{"name":"School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa"},{"name":"Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sizulu","family":"Moyo","sequence":"additional","affiliation":[{"name":"Human Sciences Research Council, Pretoria, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Shahmanesh","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"},{"name":"Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South 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