Optimal Uses of Antiretrovirals for Prevention in HIV-1 Serodiscordant Heterosexual Couples in South Africa: A Modelling Study
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{"title"=>"Optimal uses of antiretrovirals for prevention in HIV-1 serodiscordant heterosexual couples in South Africa: A modelling study", "type"=>"journal", "authors"=>[{"first_name"=>"Timothy B.", "last_name"=>"Hallett", "scopus_author_id"=>"35614255000"}, {"first_name"=>"Jared M.", "last_name"=>"Baeten", "scopus_author_id"=>"7003812564"}, {"first_name"=>"Renee", "last_name"=>"Heffron", "scopus_author_id"=>"35320040100"}, {"first_name"=>"Ruanne", "last_name"=>"Barnabas", "scopus_author_id"=>"6602463859"}, {"first_name"=>"Guy", "last_name"=>"de Bruyn", "scopus_author_id"=>"16233288300"}, {"first_name"=>"Íde", "last_name"=>"Cremin", "scopus_author_id"=>"16201739900"}, {"first_name"=>"Sinead", "last_name"=>"Delany", "scopus_author_id"=>"14120959100"}, {"first_name"=>"Geoffrey P.", "last_name"=>"Garnett", "scopus_author_id"=>"7005464007"}, {"first_name"=>"Glenda", "last_name"=>"Gray", "scopus_author_id"=>"7401812026"}, {"first_name"=>"Leigh", "last_name"=>"Johnson", "scopus_author_id"=>"8538531600"}, {"first_name"=>"James", "last_name"=>"McIntyre", "scopus_author_id"=>"7202924765"}, {"first_name"=>"Helen", "last_name"=>"Rees", "scopus_author_id"=>"7102294897"}, {"first_name"=>"Connie", "last_name"=>"Celum", "scopus_author_id"=>"7003477042"}], "year"=>2011, "source"=>"PLoS Medicine", "identifiers"=>{"pmid"=>"22110407", "doi"=>"10.1371/journal.pmed.1001123", "sgr"=>"82455205791", "isbn"=>"1549-1676 (Electronic)\\n1549-1277 (Linking)", "scopus"=>"2-s2.0-82455205791", "issn"=>"15491277", "pui"=>"363017216"}, "id"=>"e94c1a1e-8c75-3c0b-bb45-e72547d960d2", "abstract"=>"Antiretrovirals have substantial promise for HIV-1 prevention, either as antiretroviral treatment (ART) for HIV-1-infected persons to reduce infectiousness, or as pre-exposure prophylaxis (PrEP) for HIV-1-uninfected persons to reduce the possibility of infection with HIV-1. HIV-1 serodiscordant couples in long-term partnerships (one member is infected and the other is uninfected) are a priority for prevention interventions. Earlier ART and PrEP might both reduce HIV-1 transmission in this group, but the merits and synergies of these different approaches have not been analyzed.", "link"=>"http://www.mendeley.com/research/optimal-uses-antiretrovirals-prevention-hiv1-serodiscordant-heterosexual-couples-south-africa-modell", "reader_count"=>128, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Professor > Associate Professor"=>4, "Librarian"=>1, "Researcher"=>26, "Student > Doctoral Student"=>15, "Student > Ph. D. Student"=>20, "Student > Postgraduate"=>9, "Student > Master"=>29, "Other"=>6, "Student > Bachelor"=>6, "Lecturer"=>1, "Professor"=>6}, "reader_count_by_user_role"=>{"Unspecified"=>5, "Professor > Associate Professor"=>4, "Librarian"=>1, "Researcher"=>26, "Student > Doctoral Student"=>15, "Student > Ph. D. Student"=>20, "Student > Postgraduate"=>9, "Student > Master"=>29, "Other"=>6, "Student > Bachelor"=>6, "Lecturer"=>1, "Professor"=>6}, "reader_count_by_subject_area"=>{"Unspecified"=>13, "Agricultural and Biological Sciences"=>10, "Philosophy"=>1, "Business, Management and Accounting"=>5, "Chemistry"=>1, "Economics, Econometrics and Finance"=>3, "Environmental Science"=>2, "Nursing and Health Professions"=>6, "Mathematics"=>3, "Medicine and Dentistry"=>57, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>4, "Social Sciences"=>19, "Immunology and Microbiology"=>3}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>57}, "Social Sciences"=>{"Social Sciences"=>19}, "Psychology"=>{"Psychology"=>4}, "Mathematics"=>{"Mathematics"=>3}, "Unspecified"=>{"Unspecified"=>13}, "Environmental Science"=>{"Environmental Science"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Chemistry"=>{"Chemistry"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>3}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>3}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>10}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>5}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}, "Philosophy"=>{"Philosophy"=>1}}, "reader_count_by_country"=>{"United States"=>3, "Brazil"=>2, "Nigeria"=>1}, "group_count"=>19}

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  • {"files"=>["https://ndownloader.figshare.com/files/712239"], "description"=>"a<p>Mean time elapsed between entering category (CD4 cell count reaching value of upper bound) and exiting category (CD4 cell count drops below value of lower bound).</p>", "links"=>[], "tags"=>["assumptions"], "article_id"=>382592, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Timothy B. Hallett", "Jared M. Baeten", "Renee Heffron", "Ruanne Barnabas", "Guy de Bruyn", "Íde Cremin", "Sinead Delany", "Geoffrey P. Garnett", "Glenda Gray", "Leigh Johnson", "James McIntyre", "Helen Rees", "Connie Celum"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001123.t001", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Key_assumptions_made_in_the_model_/382592", "title"=>"Key assumptions made in the model.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-11-15 00:43:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/712284"], "description"=>"<p>In strategies I–III, PrEP is initiated following HIV-1 testing of couples, and, in all strategies, PrEP is stopped immediately if the HIV-1–infected partner dies or the initially HIV-1–uninfected partner becomes HIV-1 infected.</p>a<p>In this and all other scenarios, it is assumed that ART is initiated promptly when the infected partner's CD4 cell count reaches 200 cells/µl.</p>b<p>An initial period of continued PrEP is allowed until viral load becomes suppressed after ART initiation in the HIV-1–infected partner. PrEP could reasonably be discontinued after an interval of less than 1 y, or be based on viral load monitoring of the infected partner instead.</p>c<p>In the model, pregnancies can be preceded by a period of “trying to conceive a pregnancy” during which the frequency of unprotected sex increases (see <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001123#pmed.1001123.s007\" target=\"_blank\">Text S1</a>).</p>", "links"=>[], "tags"=>["strategies"], "article_id"=>382640, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Timothy B. Hallett", "Jared M. Baeten", "Renee Heffron", "Ruanne Barnabas", "Guy de Bruyn", "Íde Cremin", "Sinead Delany", "Geoffrey P. Garnett", "Glenda Gray", "Leigh Johnson", "James McIntyre", "Helen Rees", "Connie Celum"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001123.t002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_PrEP_implementation_strategies_used_in_the_model_/382640", "title"=>"PrEP implementation strategies used in the model.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-11-15 00:44:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/712191"], "description"=>"<p>The relative cost of PrEP to ART (vertical axis) and the effectiveness of PrEP (horizontal axis) are varied and the shaded region indicates the conditions where a PrEP intervention (PrEP used up to the moment that their infected partner starts treatment (at CD4<350 cells/µl)) is at least as cost-effective as earlier initiation of ART (at CD4<500 cells/µl) at allowing couples to be “alive and HIV-1 free at 50.” The dark shaded region corresponds to the “partners in prevention” assumptions about couples' behaviour and the lighter shaded region corresponds to “more typical couples” behaviour assumptions. Alternative analyses are presented where different assumptions about ART initiation and couples' behaviour are made (<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001123#pmed.1001123.s003\" target=\"_blank\">Figure S3</a>) and where the comparison is based on savings of QALYs (<a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001123#pmed.1001123.s004\" target=\"_blank\">Figure S4</a>).</p>", "links"=>[], "tags"=>["prep", "earlier", "initiation", "keeping", "couples", "hiv"], "article_id"=>382534, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Timothy B. Hallett", "Jared M. Baeten", "Renee Heffron", "Ruanne Barnabas", "Guy de Bruyn", "Íde Cremin", "Sinead Delany", "Geoffrey P. Garnett", "Glenda Gray", "Leigh Johnson", "James McIntyre", "Helen Rees", "Connie Celum"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001123.g002", "stats"=>{"downloads"=>1, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_of_PrEP_versus_earlier_ART_initiation_for_keeping_couples_8220_alive_and_HIV_free_at_50_8221_/382534", "title"=>"Comparison of PrEP versus earlier ART initiation for keeping couples “alive and HIV free at 50.”", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-11-15 00:42:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/361028", "https://ndownloader.figshare.com/files/361091", "https://ndownloader.figshare.com/files/361157", "https://ndownloader.figshare.com/files/361212", "https://ndownloader.figshare.com/files/361260", "https://ndownloader.figshare.com/files/361316", "https://ndownloader.figshare.com/files/361370"], "description"=>"<div><h3>Background</h3><p>Antiretrovirals have substantial promise for HIV-1 prevention, either as antiretroviral treatment (ART) for HIV-1–infected persons to reduce infectiousness, or as pre-exposure prophylaxis (PrEP) for HIV-1–uninfected persons to reduce the possibility of infection with HIV-1. HIV-1 serodiscordant couples in long-term partnerships (one member is infected and the other is uninfected) are a priority for prevention interventions. Earlier ART and PrEP might both reduce HIV-1 transmission in this group, but the merits and synergies of these different approaches have not been analyzed.</p> <h3>Methods and Findings</h3><p>We constructed a mathematical model to examine the impact and cost-effectiveness of different strategies, including earlier initiation of ART and/or PrEP, for HIV-1 prevention for serodiscordant couples. Although the cost of PrEP is high, the cost per infection averted is significantly offset by future savings in lifelong treatment, especially among couples with multiple partners, low condom use, and a high risk of transmission. In some situations, highly effective PrEP could be cost-saving overall. To keep couples alive and without a new infection, providing PrEP to the uninfected partner could be at least as cost-effective as initiating ART earlier in the infected partner, if the annual cost of PrEP is <40% of the annual cost of ART and PrEP is >70% effective.</p> <h3>Conclusions</h3><p>Strategic use of PrEP and ART could substantially and cost-effectively reduce HIV-1 transmission in HIV-1 serodiscordant couples. New and forthcoming data on the efficacy of PrEP, the cost of delivery of ART and PrEP, and couples behaviours and preferences will be critical for optimizing the use of antiretrovirals for HIV-1 prevention.</p> <h3></h3><p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["optimal", "uses", "antiretrovirals", "hiv-1", "serodiscordant", "heterosexual", "couples"], "article_id"=>131372, "categories"=>["Cancer", "Biotechnology"], "users"=>["Timothy B. Hallett", "Jared M. Baeten", "Renee Heffron", "Ruanne Barnabas", "Guy de Bruyn", "Íde Cremin", "Sinead Delany", "Geoffrey P. Garnett", "Glenda Gray", "Leigh Johnson", "James McIntyre", "Helen Rees", "Connie Celum"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001123.s001", "https://dx.doi.org/10.1371/journal.pmed.1001123.s002", "https://dx.doi.org/10.1371/journal.pmed.1001123.s003", "https://dx.doi.org/10.1371/journal.pmed.1001123.s004", "https://dx.doi.org/10.1371/journal.pmed.1001123.s005", "https://dx.doi.org/10.1371/journal.pmed.1001123.s006", "https://dx.doi.org/10.1371/journal.pmed.1001123.s007"], "stats"=>{"downloads"=>14, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Optimal_Uses_of_Antiretrovirals_for_Prevention_in_HIV_1_Serodiscordant_Heterosexual_Couples_in_South_Africa_A_Modelling_Study/131372", "title"=>"Optimal Uses of Antiretrovirals for Prevention in HIV-1 Serodiscordant Heterosexual Couples in South Africa: A Modelling Study", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2011-11-15 00:22:52"}
  • {"files"=>["https://ndownloader.figshare.com/files/712115"], "description"=>"<p>(A, D) The proportion of infections averted by age 50 (relative to a baseline strategy with no PrEP intervention) for four PrEP strategies (see <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001123#pmed-1001123-t002\" target=\"_blank\">Table 2</a>). (B, E) The expected mean years on PrEP (blue boxes) and years on ART averted (yellow boxes) for each of the four PrEP interventions (after discounting). (C, F) The expected cost per infection averted for each of the four PrEP interventions: the pink boxes reflect the lower PrEP cost estimates (and the higher ART cost estimates) and the blue boxes reflect the higher PrEP cost estimates (and the lower of ART cost estimates). In (A–F), the boxes shows a “feasible” range of results, which corresponds to a functional effectiveness of PrEP ranging between 50% and 80%. The assumptions used about the couple's behaviour are: (A–C) “partners in prevention” assumptions and (D–F) the “more typical couples” assumptions (see main text for details). <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001123#pmed.1001123.s002\" target=\"_blank\">Figure S2</a> shows the analysis repeated for alternative types of couples. (Summary of strategies from <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001123#pmed-1001123-t002\" target=\"_blank\">Table 2</a>: I, always PrEP; II, PrEP prior to ART with 1-y overlap; III, PrEP prior to ART (no overlap); IV, PrEP during conception/pregnancy.)</p>", "links"=>[], "tags"=>["prep", "interventions", "hiv", "infections"], "article_id"=>382466, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Timothy B. Hallett", "Jared M. Baeten", "Renee Heffron", "Ruanne Barnabas", "Guy de Bruyn", "Íde Cremin", "Sinead Delany", "Geoffrey P. Garnett", "Glenda Gray", "Leigh Johnson", "James McIntyre", "Helen Rees", "Connie Celum"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001123.g001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_impact_of_different_PrEP_interventions_on_HIV_infections_in_the_couple_/382466", "title"=>"The impact of different PrEP interventions on HIV infections in the couple.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-11-15 00:41:06"}

PMC Usage Stats | Further Information

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Relative Metric

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