Table 2

Outcomes over 20 years of various strategies to scale up single or combination HIV prevention and treatment programs: Guidelines antiretroviral therapy (individuals with CD4 cell counts ≤350 cells/μL only), Universal antiretroviral therapy (all HIV-infected individuals), General pre-exposure prophylaxis (general population), Focused pre-exposure prophylaxis (individuals at high risk of acquiring HIV)
ART Guidelines portfolios Base case (50% Guidelines ART, 0% General PrEP) (50% Guidelines ART, 50% General PrEP) (50% Guidelines ART, 100% General PrEP) (100% Guidelines ART, 0% General PrEP) (100% Guidelines ART, 50% General PrEP) (100% Guidelines ART, 100% General PrEP)
Total Population 28,899,757 30,584,812 31,140,505 31,243,269 31,155,266 31,559,954 31,637,147
HIV population 3,010,186 2,952,938 1,957,738 1,857,875 2,924,495 2,038,587 1,946,176
HIV prevalence 10.4% 9.7% 6.3% 5.9% 9.4% 6.5% 6.2%
PrEP entry 0% 0% 50% 100% 0% 50% 100%
ART entry
(late and advanced) 10% 50% 50% 50% 100% 100% 100%
ART entry
(early) 0% 0% 0% 0% 0% 0% 0%
Started ART 1,898,565 4,291,707 3,525,062 3,400,388 4,983,325 4,178,534 4,048,308
Total QALYs
(millions) 939 982 1,003 1,007 998 1,015 1,017
Total costs
($ billions) $282.2 $299.8 $343.5 $349.0 $306.0 $350.8 $356.5
Infections averted 1,512,972 3,545,397 3,826,716 2,030,990 3,751,962 3,993,700
CE ratio $413 $958 $992 $408 $914 $954
ART Universal portfolios Base case (50% Universal ART, 0% General PrEP) (50% Universal ART, 50% General PrEP) (50% Universal, 100% General PrEP) (100% Universal ART, 0% General PrEP) (100% Universal ART, 50% General PrEP) (100% Universal ART, 100% General PrEP)
Total Population 28,899,757 31,957,916 32,099,883 32,135,197 32,344,976 32,424,302 32,444,183
HIV population 3,010,186 2,429,248 2,020,691 1,965,384 2,372,222 2,045,369 2,002,584
HIV prevalence 10.4% 7.6% 6.3% 6.1% 7.3% 6.3% 6.2%
PrEP entry 0% 0% 50% 100% 0% 50% 100%
ART entry
(late and advanced) 10% 50% 50% 50% 100% 100% 100%
ART entry
(early) 0% 50% 50% 50% 100% 100% 100%
Started ART 1,898,565 5,605,789 4,997,687 4,883,560 5,946,284 5,442,264 5,354,623
Total QALYs
(millions) 939 1,025 1,031 1,033 1,037 1,041 1,042
Total costs
($ billions) $282.2 $309.1 $360.2 $366.2 $312.3 $365.7 $372.1
Infections averted 3,591,057 4,356,210 4,494,263 4,014,941 4,579,560 4,675,735
CE ratio $314 $849 $902 $307 $819 $876
Focused PrEP portfolios Base case (10% Guidelines ART, 50% Focused PrEP) (10% Guidelines ART, 100% Focused PrEP) (50% Guidelines ART, 100% Focused PrEP) (100% Guidelines ART, 100% Focused PrEP) (50% Universal ART, 100% Focused PrEP) (100% Universal ART, 100% Focused PrEP)
Total Population 28,899,757 29,582,098 30,075,564 31,218,742 31,624,528 32,147,612 32,457,488
HIV population 3,010,186 2,232,122 1,743,582 1,983,526 2,059,891 2,010,021 2,038,731
HIV prevalence 10.4% 7.55% 5.8% 6.4% 6.5% 6.3% 6.3%
PrEP entry 0% 50% 100% 100% 100% 100% 100%
ART entry
(late and advanced) 10% 10% 10% 50% 100% 50% 100%
ART entry
(early) 0% 0% 0% 0% 0% 50% 100%
Started ART 1,898,565 1,639,299 1,454,123 3,455,184 4,104,640 4,897,716 5,362,426
Total QALYs
(millions) 939 962 978 1,006 1,016 1,033 1,042
Total costs
($ billions) $282.2 $277.1 274.9 292.9 299.8 307.9 313.3
Infections averted 1,837,744 3,084,508 3,642,543 3,840,111 4,468,827 4,663,411
CE ratio Cost saving Cost saving $163 $229 $276 $302
General PrEP portfolios Base case (10% Guidelines ART, 50% General PrEP) (10% Guidelines ART, 100% General PrEP)
Total Population 28,899,757 29,970,799 30,151,535
HIV population 3,010,186 1,693,209 1,579,445
HIV prevalence 10.4% 5.65% 5.24%
PrEP entry 0% 50% 100%
ART entry
(late and advanced) 10% 10% 10%
ART entry
(early) 0% 0% 0%
Started ART 1,898,565 1,485,240 1,420,126
Total QALYs
(millions) 939 975 980
Total costs
($ billions) $282.2 $323.9 $329.6
Infections averted 2,998,344 3,381,214
CE ratio $1,172 $1,158

ART, antiretroviral therapy; CE, cost -effectiveness; PrEP, pre-exposure prophylaxis; QALY, quality-adjusted life-year.

Alistar et al.

Alistar et al. BMC Medicine 2014 12:46   doi:10.1186/1741-7015-12-46

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