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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update

SOUTH AFRICA: Epidemiological Impact of Tenofovir Gel on the HIV Epidemic in South Africa


Journal of Acquired Immune Deficiency Syndromes Vol. 58; No.

In a previous randomized controlled trial in South Africa, a tenofovir-based vaginal microbicide gel reduced HIV acquisition in women by 39 percent. To better inform policy, the current study assessed the population-level impact of this antiretroviral-based gel on HIV incidence, prevalence and deaths, and cost-effectiveness, using a dynamic model of HIV transmission calibrated to South Africa's epidemic.

The results showed that if used by women in 80 percent or more of sexual encounters (high coverage), the gel could prevent 2.33 (0.12 to 4.63) million new infections and save 1.30 (0.07 to 2.42) million lives over the next 20 years. A lower coverage, use of the gel in only 25 percent of sexual encounters, could avert 0.50 (0.04 to 0.77) million new infections and save 0.29 (0.02 to 0.44) million lives over the next 20 years.

At $0.50 per application, the cost per HIV infection prevented at low coverage would be $2,392 ($562 to $4,222), and the cost per disability-adjusted life year saved would be $104 ($27 to $181). High coverage would cut these costs by about 30 percent.

"Over 20 years, the use of tenofovir gel in South Africa could avert up to 2 million new infections and 1 million AIDS deaths," the study authors concluded. "Even with low rates of gel use, it is highly cost-effective and compares favorably with other control methods. This female-controlled prevention method could have a significant impact on the epidemic of HIV in South Africa. Programs should aim to achieve gel use in more than 25 percent of sexual encounters to significantly alter the course of the epidemic."


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Information in this article was accurate in October 24, 2011. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.