title: Estimating the cost-effectiveness of pre-exposure prophylaxis to reduce HIV-1 and HSV-2 incidence in HIV-serodiscordant couples in South Africa.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of daily oral tenofovir-based PrEP, with a protective effect against HSV-2 as well as HIV-1, among HIV-1 serodiscordant couples in South Africa.
  
  
  METHODS
  We incorporated HSV-2 acquisition, transmission, and interaction with HIV-1 into a microsimulation model of heterosexual HIV-1 serodiscordant couples in South Africa, with use of PrEP for the HIV-1 uninfected partner prior to ART initiation for the HIV-1 1infected partner, and for one year thereafter.
  
  
  RESULTS
  We estimate the cost per disability-adjusted life-year (DALY) averted for two scenarios, one in which PrEP has no effect on reducing HSV-2 acquisition, and one in which there is a 33% reduction. After a twenty-year intervention, the cost per DALY averted is estimated to be $10,383 and $9,757, respectively--a 6% reduction, given the additional benefit of reduced HSV-2 acquisition. If all couples are discordant for both HIV-1 and HSV-2, the cost per DALY averted falls to $1,445, which shows that the impact is limited by HSV-2 concordance in couples.
  
  
  CONCLUSIONS
  After a 20-year PrEP intervention, the cost per DALY averted with a reduction in HSV-2 is estimated to be modestly lower than without any effect, providing an increase of health benefits in addition to HIV-1 prevention at no extra cost. The small degree of the effect is in part due to a high prevalence of HSV-2 infection in HIV-1 serodiscordant couples in South Africa.
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors.forename: Britta L
authors.initials: BL
authors.lastname: Jewell
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors.forename: Ide
authors.initials: I
authors.lastname: Cremin
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Pickles
authors.affiliation: Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: Departments of Global Health, Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.affiliation: Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D019546:Couples Therapy / Q000191:economics*; D005191:Family Characteristics; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015528:HIV Seroprevalence; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D065129:Pre-Exposure Prophylaxis / Q000191:economics*; D013019:South Africa; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine