In India, pre-exposure prophylaxis (PrEP), a combination drug used to prevent HIV infection would be a cost-effective way to reduce the spread of HIV and increase survival, stated a new study published in Clinical Infectious Diseases.
"We know PrEP helps stop the spread of infection; the question is whether it is a good use of limited resources? Our study shows that PrEP is a cost-effective strategy for both MSM and PWID in India. For these groups, especially in areas with high HIV incidence, PrEP is worth rolling out," says lead and corresponding author Pooyan Kazemian, PhD, of the Massachusetts General Hospital (MGH) Medical Practice Evaluation Center, an instructor in Medicine at Harvard Medical School.
Using a widely-published mathematical model to project clinical and economic outcomes of HIV disease, the authors compared various prevention and testing programs - including annual or biannual HIV testing alone, as well as PrEP paired with HIV testing - that could help reduce HIV infection and therefore improve survival for these high-risk groups. Their findings suggest that PrEP would increase survival substantially by reducing infection risk, while more frequent HIV testing would provide little additional benefit. PrEP paired with biannual HIV testing was the only cost-effective strategy, improving average per-person survival by nearly one year and preventing more than 270,000 HIV transmissions in India over 15 years.
However, the authors note, a nationwide PrEP rollout would be quite costly. If nearly 60 percent of MSM and PWID across India participated in the program, it would increase HIV care expenditures by over 900 million U.S. dollars over a 5-year period. "Our findings suggest that geographic areas of highest HIV incidence should be targeted first to reduce the budget required," says co-author Nomita Chandhiok, MBBS, DGO, PhD, of the Indian Council of Medical Research in New Delhi.