Table 1.
Key parameter values, ranges, and sources.
Figure 1.
HIV prevalence over 20 years for alternative strategies.
Prevalence is shown for the status quo and alternative strategies of scaling up antiretroviral therapy (ART) to 80% of all eligible individuals, methadone maintenance treatment (MMT) for 25% of injection drug users (IDUs), and introducing oral pre-exposure prophylaxis (PrEP) for 25% or 50% of uninfected IDUs.
Table 2.
Base case results.*
Figure 2.
HIV infections averted over 20 years for alternative strategies.
Infections averted are shown for alternative strategies of scaling up antiretroviral therapy (ART) to 80% of all eligible individuals, methadone maintenance treatment (MMT) to 25% of injection drug users (IDUs), and introducing oral pre-exposure prophylaxis (PrEP) for 25% or 50% of uninfected IDUs.
Figure 3.
Cost effectiveness of alternative prevention and treatment strategies.
Assumes annual PrEP cost of $950 (Figure 3a) and $450 (Figure 3b). PrEP = oral pre-exposure prophylaxis for injection drug users; ART = antiretroviral therapy for 80% of eligible individuals; MMT = methadone maintenance treatment for 25% of IDUs; 25% PrEP = PrEP for 25% of uninfected IDUs; 50% PrEP = PrEP for 50% of uninfected IDUs.
Figure 4.
Breakeven effectiveness for PrEP as a function of its annual cost.
Effectiveness is measured as percentage reduction in chance of HIV infection acquisition. Assumes 25% of uninfected IDUs are enrolled in PrEP, in comparison to the status quo (no scale up of MMT or ART). Bottom line (triangles) shows minimum effectiveness for which PrEP would be considered highly cost effective (ICER = $7,400). Middle line (diamonds) shows minimum effectiveness for which PrEP would be as cost effective as MMT (ICER = $520). Top line (squares) shows minimum effectiveness for which PrEP would be cost saving (ICER = $0). PrEP = oral pre-exposure prophylaxis for injection drug users; ART = antiretroviral therapy; MMT = methadone maintenance therapy; ICER = incremental cost-effectiveness ratio.