16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

MODELING THE POTENTIAL IMPACT OF HIV CHEMOPROPHYLAXIS STRATEGIES AMONG MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES: HIV INFECTIONS PREVENTED AND COST-EFFECTIVENESS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAd0101

Desai K.¹, McGreevey W.P.², Ackers M.L.³, Hall H.I.³, Hu D.J.³, Sanders R.², Sansom S.L.³, Scotton C.R.³, Soorapanth S.³, Stewart S.R.⁴, Boily M.C.¹, Garnett G.P.¹, McElroy P.D.^3
1 Imperial College London, Infectious Disease Epidemiology, St-Mary's Hospital, Norfolk Place, London, United Kingdom, ² Futures Group International, Washington DC, United States, ³ U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta GA, United States, ⁴ University of North Carolina at Chapel Hill, Chapel Hill, United States

BACKGROUND: HIV chemoprophylaxis may be a future prevention strategy to help control the global epidemic of HIV/AIDS. Safety and efficacy trials of tenofovir disoproxil fumarate (TDF) are currently underway. We assessed the potential number of HIV infections prevented and cost-effectiveness of a once daily regimen of TDF in high risk men who have sex with men (MSM) in New York City (NYC).

METHODS: We developed a stochastic compartmental mathematical model simulating the HIV epidemic and the impact of a 5-year chemoprophylaxis program on HIV infections. We validated the model using HIV/AIDS surveillance data. We varied the coverage of high-risk MSM (2.5% to 25%), annual number of sex partners (1 – 30), program adherence (33% – 95%), protective efficacy (30% – 70%) and mechanism of protection. We estimated program costs from the perspective of the US health system and calculated the incremental cost per quality-adjusted life-year (QALY) saved compared with current HIV prevention practices under a wide variety of program parameters and costs.

RESULTS: From 2005 to 2010, a chemoprophylaxis program targeting 25% of high-risk MSM in NYC could prevent 710 (4%) to 3860 (21%) of the 18,720 HIV infections otherwise expected. More than half of these are prevented indirectly through a herd effect resulting from reduced HIV prevalence in the community. Under base-case assumptions, the incremental cost was $11,680 (range $8,640 – 12,060)per QALY saved. The program was cost effective under most variations in efficacy, mechanism of protection, adherence and costs of HIV care.

CONCLUSIONS: Even with modest levels of efficacy, HIV chemoprophylaxis among high-risk MSM in a major US city could prevent a significant number of HIV infections and be cost effective.

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2006-08-13
ThAd0101

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