title: Identifying Key Drivers of the Impact of an HIV Cure Intervention in Sub-Saharan Africa.
abstract: It is unknown what properties would be required to make an intervention in low income countries that can eradicate or control human immunodeficiency virus (HIV) without antiretroviral therapy (ART) cost-effective.
  
  
  
  We used a model of HIV and ART to investigate the effect of introducing an ART-free viral suppression intervention in 2022 using Zimbabwe as an example country. We assumed that the intervention (cost: $500) would be accessible for 90% of the population, be given to those receiving effective ART, have sufficient efficacy to allow ART interruption in 95%, with a rate of viral rebound of 5% per year in the first 3 months, and a 50% decline in rate with each successive year.
  
  
  
  An ART-free viral suppression intervention with these properties would result in >0.53 million disability-adjusted-life-years averted over 2022-2042, with a reduction in HIV program costs of $300 million (8.7% saving). An intervention of this efficacy costing anything up to $1400 is likely to be cost-effective in this setting.
  
  
  
  Interventions aimed at curing HIV infection have the potential to improve overall disease burden and to reduce costs. Given the effectiveness and cost of ART, such interventions would have to be inexpensive and highly effective.
authors.affiliation: Research Department of Infection & Population Health, UCL.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.affiliation: Research Department of Infection & Population Health, UCL.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.affiliation: Centre for Health Economics, University of York, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Revill
authors.affiliation: Research Department of Infection & Population Health, UCL.
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Nakagawa
authors.affiliation: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.affiliation: Research Department of Infection & Population Health, UCL.
authors.forename: Loveleen
authors.initials: L
authors.lastname: Bansi-Matharu
authors.affiliation: University of Zimbabwe.
authors.forename: Travor
authors.initials: T
authors.lastname: Mabugu
authors.affiliation: Centre for Health Economics, University of York, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Geoff
authors.initials: G
authors.lastname: Garnett
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, Washington.
authors.forename: Silvija
authors.initials: S
authors.lastname: Staprans
authors.affiliation: Independent Consultant in HIV Global Health, Yountville, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Becker
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Joseph
authors.initials: J
authors.lastname: Murungu
authors.affiliation: The Peter Doherty Institute for Infection and Immunity, University of Melbourne Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Lewin
authors.affiliation: San Francisco General Hospital Medical Center, California.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.affiliation: Department of Infectious Disease Epidemiology, Imperial College London.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000639:trends*; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011203:Poverty; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; antiretroviral therapy; cure; economic evaluation; model