Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis
Abstract Introduction Long‐acting injectable cabotegravir (CAB‐LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for human immunodeficiency virus (HIV) pre‐exposure prophylaxis (PrEP) in two clinical trials. This analysis projects the impact of expanding PrE...
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| Format: | Article |
| Language: | English |
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Wiley
2025-07-01
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| Series: | Journal of the International AIDS Society |
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| Online Access: | https://doi.org/10.1002/jia2.26453 |
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| author | Sarah E. Stansfield Mia Moore Lise Jamieson Gesine Meyer‐Rath Leigh F. Johnson David Kaftan Anna Bershteyn Jennifer Smith Valentina Cambiano Loveleen Bansi‐Matharu Andrew Phillips Jesse Heitner Ruanne V. Barnabas Brett Hanscom Deborah J. Donnell Marie‐Claude Boily Dobromir Dimitrov |
| author_facet | Sarah E. Stansfield Mia Moore Lise Jamieson Gesine Meyer‐Rath Leigh F. Johnson David Kaftan Anna Bershteyn Jennifer Smith Valentina Cambiano Loveleen Bansi‐Matharu Andrew Phillips Jesse Heitner Ruanne V. Barnabas Brett Hanscom Deborah J. Donnell Marie‐Claude Boily Dobromir Dimitrov |
| author_sort | Sarah E. Stansfield |
| collection | DOAJ |
| description | Abstract Introduction Long‐acting injectable cabotegravir (CAB‐LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for human immunodeficiency virus (HIV) pre‐exposure prophylaxis (PrEP) in two clinical trials. This analysis projects the impact of expanding PrEP coverage with CAB‐LA in South Africa between 2022 and 2042. Methods Three independently calibrated models of HIV transmission in South Africa (Synthesis, EMOD‐HIV, Thembisa) projected HIV acquisitions and effective coverage (average PrEP coverage across exposure groups, weighted by HIV incidence in the absence of PrEP in each group) over 20 years under multiple scenarios of PrEP expansion compared to no PrEP expansion. PrEP expansion scenarios differed in targeted overall coverage, speed of expansion, coverage of high‐exposure groups, and relative coverage of women and men. Results Achieving 5% PrEP coverage with CAB‐LA by 2032 prioritizing high‐exposure groups resulted in 49% (Synthesis), 18% (EMOD‐HIV), and 8% (Thembisa) effective coverage and averted a median of 43%, 29% and 10% of new HIV acquisitions, respectively. Similar expansion with TDF/FTC resulted in lower impact by 19 percentage points (pp), 18pp and 3pp, respectively. Increasing CAB‐LA coverage to 15% led to an additional 7pp, 12pp and 16pp, respectively, of HIV acquisitions averted. Achieving 5% CAB‐LA coverage expanding to women only resulted in a lower impact by 16pp (Synthesis) and 13pp (EMOD‐HIV), and a higher impact by 2pp (Thembisa). Scenarios with similar effective coverage resulted in comparable impact estimates across models. Conclusions Offering CAB‐LA in South Africa may substantially impact the HIV epidemic based on these projections. Effective coverage proved to be a good predictor of intervention effectiveness. |
| format | Article |
| id | doaj-art-e5bb641cfa334ae0ae899a46017047a9 |
| institution | DOAJ |
| issn | 1758-2652 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj-art-e5bb641cfa334ae0ae899a46017047a92025-08-20T02:42:39ZengWileyJournal of the International AIDS Society1758-26522025-07-0128S2n/an/a10.1002/jia2.26453Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysisSarah E. Stansfield0Mia Moore1Lise Jamieson2Gesine Meyer‐Rath3Leigh F. Johnson4David Kaftan5Anna Bershteyn6Jennifer Smith7Valentina Cambiano8Loveleen Bansi‐Matharu9Andrew Phillips10Jesse Heitner11Ruanne V. Barnabas12Brett Hanscom13Deborah J. Donnell14Marie‐Claude Boily15Dobromir Dimitrov16Fred Hutchinson Cancer Center Seattle Washington USAFred Hutchinson Cancer Center Seattle Washington USAHealth Economics and Epidemiology Research Office Faculty of Health Sciences University of the Witwatersrand Johannesburg South AfricaHealth Economics and Epidemiology Research Office Faculty of Health Sciences University of the Witwatersrand Johannesburg South AfricaUniversity of Cape Town Rondebosch South AfricaNew York University Grossman School of Medicine New York New York USANew York University Grossman School of Medicine New York New York USAUniversity College London London UKUniversity College London London UKUniversity College London London UKUniversity College London London UKDivision of Infectious Diseases Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USADivision of Infectious Diseases Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USAFred Hutchinson Cancer Center Seattle Washington USAFred Hutchinson Cancer Center Seattle Washington USAMRC Centre for Global Infectious Disease Analysis School of Public Health, Imperial College London London UKFred Hutchinson Cancer Center Seattle Washington USAAbstract Introduction Long‐acting injectable cabotegravir (CAB‐LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for human immunodeficiency virus (HIV) pre‐exposure prophylaxis (PrEP) in two clinical trials. This analysis projects the impact of expanding PrEP coverage with CAB‐LA in South Africa between 2022 and 2042. Methods Three independently calibrated models of HIV transmission in South Africa (Synthesis, EMOD‐HIV, Thembisa) projected HIV acquisitions and effective coverage (average PrEP coverage across exposure groups, weighted by HIV incidence in the absence of PrEP in each group) over 20 years under multiple scenarios of PrEP expansion compared to no PrEP expansion. PrEP expansion scenarios differed in targeted overall coverage, speed of expansion, coverage of high‐exposure groups, and relative coverage of women and men. Results Achieving 5% PrEP coverage with CAB‐LA by 2032 prioritizing high‐exposure groups resulted in 49% (Synthesis), 18% (EMOD‐HIV), and 8% (Thembisa) effective coverage and averted a median of 43%, 29% and 10% of new HIV acquisitions, respectively. Similar expansion with TDF/FTC resulted in lower impact by 19 percentage points (pp), 18pp and 3pp, respectively. Increasing CAB‐LA coverage to 15% led to an additional 7pp, 12pp and 16pp, respectively, of HIV acquisitions averted. Achieving 5% CAB‐LA coverage expanding to women only resulted in a lower impact by 16pp (Synthesis) and 13pp (EMOD‐HIV), and a higher impact by 2pp (Thembisa). Scenarios with similar effective coverage resulted in comparable impact estimates across models. Conclusions Offering CAB‐LA in South Africa may substantially impact the HIV epidemic based on these projections. Effective coverage proved to be a good predictor of intervention effectiveness.https://doi.org/10.1002/jia2.26453adherenceCAB‐LAHIV preventionmodellingpre‐exposure prophylaxisSouth Africa |
| spellingShingle | Sarah E. Stansfield Mia Moore Lise Jamieson Gesine Meyer‐Rath Leigh F. Johnson David Kaftan Anna Bershteyn Jennifer Smith Valentina Cambiano Loveleen Bansi‐Matharu Andrew Phillips Jesse Heitner Ruanne V. Barnabas Brett Hanscom Deborah J. Donnell Marie‐Claude Boily Dobromir Dimitrov Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis Journal of the International AIDS Society adherence CAB‐LA HIV prevention modelling pre‐exposure prophylaxis South Africa |
| title | Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis |
| title_full | Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis |
| title_fullStr | Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis |
| title_full_unstemmed | Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis |
| title_short | Estimated impact of long‐acting injectable PrEP in South Africa: a model comparison analysis |
| title_sort | estimated impact of long acting injectable prep in south africa a model comparison analysis |
| topic | adherence CAB‐LA HIV prevention modelling pre‐exposure prophylaxis South Africa |
| url | https://doi.org/10.1002/jia2.26453 |
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