Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-2 (of 2 Records) |
Query Trace: Koppenhaver RT [original query] |
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Antiretroviral prophylaxis for sexual and injection drug use acquisition of HIV
Campbell JD , Herbst JH , Koppenhaver RT , Smith DK . Am J Prev Med 2013 44 S63-9 During the past few years, much has been learned about pre-exposure prophylaxis (PrEP) of HIV from studies conducted in the U.S. and elsewhere. A review and summary was conducted of articles and reports published through August 2012 on the safety and efficacy of PrEP in humans; U.S.-based studies assessing PrEP knowledge, attitudes, and use among at-risk populations and healthcare providers; and models of the cost effectiveness of PrEP. PrEP is generally safe and effective and may be cost effective in a targeted population. Awareness and interest in PrEP are increasing. PrEP is an important new addition to HIV prevention services, but continued study is warranted. |
The cost-effectiveness of pre-exposure prophylaxis in men who have sex with men in the United States: an epidemic model
Koppenhaver RT , Sorensen SW , Farnham PG , Sansom SL . J Acquir Immune Defic Syndr 2011 58 (2) e51-2 The HIV epidemic has disproportionately affected men who have sex with men (MSM). As recently as 2006, the Centers for Disease Control and Prevention reports that MSM in the United States accounted for more than 50% of new HIV infections although representing only 2% of the US population.1 The Centers for Disease Control and Prevention also reports that in 2008, HIV prevalence among MSM in 21 major US cities was 19% with 44% being unaware of their infection. A recent study suggests that chemoprophylaxis before exposure or pre-exposure prophylaxis (PrEP) may be an effective approach to combating the incidence of HIV in the MSM community. This study showed that a daily dose of tenofovir/emtricitabine reduced HIV incidence in susceptible MSM2 by 44% overall and 73% among those who were highly adherent (high adherence defined as taking >90% of doses, determined by pill count). This suggests that PrEP has the potential to significantly reduce the HIV epidemic in the Unite States, where MSM have the highest annual incidence rate among all risk groups. Preliminary study data also indicated that, among a small sample of participants, US participants were more likely to have detectable levels of tenofovir/emtricitabine than non-US participants, suggesting that adherence rates might be high in the United States.3 However, its cost-effectiveness and overall effect on the epidemic have not been addressed in the context of these findings. | We constructed a dynamic compartmental model of MSM in an urban setting that shows changes over time in the number of susceptible and infected individuals and the various disease stages of infected individuals. We used epidemic data from New York City and national-level behavioral data. We gathered costs of implementing PrEP,4 in addition to those for tenofovir/emtricitabine (valued at $22/day).5 Our model assumed all susceptible MSM received PrEP and quarterly HIV testing and monitoring for adverse events. We assumed a 20-year time horizon and discounted the future costs, infections averted, and quality-adjusted life-years saved (QALYs) reported in incremental cost-effectiveness ratios at 3% per year. We divided PrEP drug and implementation costs by the number of cases prevented to determine the cost per case prevented. We divided PrEP drug and implementation costs minus treatment costs associated with HIV cases prevented by quality-adjusted life-years saved to determine the incremental cost-effectiveness ratio. We assumed that the costs of PrEP were fully incurred, regardless of adherence. For the purposes of this model, we compared the PrEP program described above with a scenario in which about 25% of susceptible and undiagnosed MSM are tested per year based on model projections that correspond to current epidemic trends. |
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- Page last updated:Sep 16, 2024
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