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
"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."