{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T11:59:14Z","timestamp":1768564754481,"version":"3.49.0"},"posted":{"date-parts":[[2023,11,7]]},"group-title":"HIV\/AIDS","reference-count":42,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,11,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Approximately 130 000 infants acquire HIV annually despite global maternal antiretroviral therapy scale-up. We evaluated the potential clinical impact and cost-effectiveness of offering long-acting, anti-HIV broadly neutralizing antibody (bNAb) prophylaxis to infants in three distinct settings.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We simulated infants in C\u00f4te d\u2019Ivoire, South Africa, and Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Pediatric (CEPAC-P) model. We modeled strategies offering a three-bNAb combination in addition to WHO-recommended standard-of-care oral prophylaxis to infants: a) with known, WHO-defined high-risk HIV exposure at birth (\n                    <jats:italic>HR-HIVE<\/jats:italic>\n                    ); b) with known HIV exposure at birth (\n                    <jats:italic>HIVE<\/jats:italic>\n                    ); or c) with or without known HIV exposure (\n                    <jats:italic>ALL<\/jats:italic>\n                    ). Modeled infants received\n                    <jats:italic>1-dose<\/jats:italic>\n                    ,\n                    <jats:italic>2-doses<\/jats:italic>\n                    , or\n                    <jats:italic>Extended<\/jats:italic>\n                    (every 3 months through 18 months) bNAb dosing. Base case model inputs included 70% bNAb efficacy (sensitivity analysis range: 10-100%), 3-month efficacy duration\/dosing interval (1-6 months), and $20\/dose cost ($5-$100\/dose). Outcomes included pediatric HIV infections, life expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, in US$\/year-of-life-saved [YLS], assuming a\n                    <jats:underline>&lt;<\/jats:underline>\n                    50% GDP per capita cost-effectiveness threshold).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    The base case model projects that bNAb strategies targeting\n                    <jats:italic>HIVE<\/jats:italic>\n                    and\n                    <jats:italic>ALL<\/jats:italic>\n                    infants would prevent 7-26% and 10-42% additional pediatric HIV infections, respectively, compared to standard-of-care alone, ranging by dosing approach.\n                    <jats:italic>HIVE-Extended<\/jats:italic>\n                    would be cost-effective (cost-saving compared to standard-of-care) in C\u00f4te d\u2019Ivoire and Zimbabwe;\n                    <jats:italic>ALL-Extended<\/jats:italic>\n                    would be cost-effective in South Africa (ICER: $882\/YLS). BNAb strategies targeting\n                    <jats:italic>HR-HIVE<\/jats:italic>\n                    infants would result in greater lifetime costs and smaller life expectancy gains than\n                    <jats:italic>HIVE-Extended<\/jats:italic>\n                    . Throughout most bNAb efficacies and costs evaluated in sensitivity analyses, targeting\n                    <jats:italic>HIVE<\/jats:italic>\n                    infants would be cost-effective in C\u00f4te d\u2019Ivoire and Zimbabwe, and targeting\n                    <jats:italic>ALL<\/jats:italic>\n                    infants would be cost-effective in South Africa.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Adding long-acting bNAbs to current standard-of-care prophylaxis would be cost-effective, assuming plausible efficacies and costs. The cost-effective target population would vary by setting, largely driven by maternal antenatal HIV prevalence and postpartum incidence.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2023.11.06.23298184","type":"posted-content","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T15:50:18Z","timestamp":1699372218000},"source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of broadly neutralizing antibodies for infant HIV prophylaxis in settings with high HIV burdens: a simulation modeling study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-7656","authenticated-orcid":false,"given":"Christopher","family":"Alba","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelly","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Horsfall","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew E.","family":"Barnhart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrie","family":"Bekker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katerina","family":"Chapman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Coleen K.","family":"Cunningham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia E.","family":"Fast","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Genevieve G.","family":"Fouda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth A.","family":"Freedberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameena","family":"Goga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lusine R.","family":"Ghazaryan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9riane","family":"Leroy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlyn","family":"Mann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret M.","family":"McCluskey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth J.","family":"McFarland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Muturi-Kioi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sallie R.","family":"Permar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devin","family":"Sok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynda","family":"Stranix-Chibanda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milton C.","family":"Weinstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea L.","family":"Ciaranello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin M.","family":"Dugdale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2023111006300885000_2023.11.06.23298184v1.1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS). 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