October 6, 2015
Annick Borquez, Ph.D., a specialist on using mathematical modeling to estimate the contribution of different sources of risk to HIV incidence in various populations and settings, spoke on a Sept. 3 webinar hosted by the Network for Multidisciplinary Studies on ARV-Based HIV Prevention (NEMUS). She discussed a mathematical model for estimating the effectiveness and cost-effectiveness of various HIV-prevention approaches among transgender women sex workers (TWS) in Lima, Peru. This is a substudy of a larger study of HIV prevention models among men who have sex with men (MSM) and transgender women (TW) in Peru. The mathematical model is the third phase of the study, and was preceded by a stakeholder analysis and a capacity analysis of the Peruvian health system.
The model is based on the following estimates:
Twenty-three different combinations of the following interventions were considered in the model:
All interventions assume a substantial increase in the current 25% HIV-testing rate in this population. The cost of HIV testing was folded into the cost of the various treatment interventions, but the cost of social interventions -- such as combatting stigma and discrimination -- was not included in the model.
According to the model, the highest number of HIV infections averted over 10 years (4,500) would be achieved if all interventions were combined. This would also cost the most, especially considering the current price of tenofovir/emtricitabine (Truvada), the drug used for PrEP (US$ 120/month). The Peruvian government is negotiating a discount, which may reduce the price to US$ 30/month.
The model suggests that averting 50% of new HIV infections over the next 10 years could be achieved or almost achieved with any one of these combined approaches:
In 2014, Peru spent almost 282 million nuevo soles (US$ 88 million at current rate of exchange) on HIV prevention and treatment. The most cost-effective approach would be option 3, at an estimated cost of 11 million nuevo soles over 10 years. Ms. Borquez cautioned, however, that "intervention access and uptake among this marginalized population requires an improvement in their environment."
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
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