CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

1058 Cost-Effectiveness of the Intravaginal Dapivirine Ring: A Modeling Analysis Jennifer Smith 1 ; Kate Harris 2 ; Geoff Garnett 2 ; LutVan Damme 2 ;Timothy Hallett 1 1 Imperial Coll London, London, UK; 2 Bill and Melinda Gates Fndn, Seattle, WA, USA Background: New female-controlled products are urgently needed for HIV prevention and intravaginal rings (IVRs) that release antiretroviral drugs such as dapivirine (DPV) are one technology being developed. Two phase III trials of a monthly DPV ring are underway and expect to report efficacy results in late 2015 and early 2016. Methods: We modeled the introduction of the DPV ring in South Africa from 2017, assuming a range of efficacy estimates (25%, 50%, 75%). The intervention was highly prioritized to high-risk women (30% coverage among sex workers and 10% among other women with multiple sexual partners) and introduced under different assumptions about the counterfactual scenario: (1) current levels of existing HIV prevention methods (condom use, male circumcision, early ART) are maintained over time; (2) existing prevention methods increase over time; (3) as (2) with the addition of oral PrEP. We assumed a one-off fixed cost of 10 million USD for the introduction of the DPV ring plus 5 million USD per

year for mass media. The variable cost ranged from 107-115 USD per person per year depending on the population sub-group, and we assume that prevention and treatment interventions call on the same overall ‘HIV budget’. We estimated the health impact and cost-effectiveness of the DPV ring relative to the three counterfactual scenarios per disability adjusted life year (DALY) averted. All costs are discounted at 3% per year. Results: The DPV ring could avert 125-175 thousand, 265-364 thousand or 427-588 thousand infections at 25%, 50% and 75% efficacy, respectively, from 2017-2050 under the different counterfactual scenarios. This represents 1.1-1.9%, 2.5-4.2% and 4.0-7.0% of total HIV infections in this period at corresponding cost-effectiveness of 1000-1300, 370-520 and 160-260 USD per DALY averted (Figure 1). All cost-effectiveness estimates are below 25% of South African GDP per capita. Conclusions: The DPV ring could substantially and cost-effectively generate health among women in South Africa even under the lowest efficacy estimates, provided it can be successfully prioritised to those at greatest risk. However cost-effectiveness does not necessarily imply the intervention is affordable and in other settings the ring my be less likely to be cost-effective. The success of the DPV ring will also be determined by user demand and adherence, and new and forthcoming data on women’s preferences will be critical for determining its use across different settings.

1059 Determinants of Economic Efficiency in HIV Prevention: Evidence From ORPHEA Kenya Omar Galarraga 1 ; RichardWamai 2 ; Sandra G. Sosa-Rubi 3 ; Mercy Mugo 4 ; David Contreras 3 ; Sergio Bautista-Arredondo 3 ; Helen Nyakundi 4 ; JosephWang’Ombe 4 1 Brown Univ Sch of PH, Providence, RI, USA; 2 Northeastern Univ, Boston, MA, USA; 3 INSP, Cuernavaca, Mexico; 4 Univ of Nairobi, Nairobi, Kenya Background: We analyze determinants of economic efficiency for three HIV prevention interventions in Kenya: HIV testing & counselling (HTC), prevention of mother-to-child transmission (PMTCT), and male circumcision (MC). As part of the “Optimizing the Response of Prevention: HIV Efficiency in Africa” (ORPHEA) project, input data were collected retrospectively from sample of government and non-governmental health facilities for 2011-12.

Methods: Multi-stage sampling was used to determine the sample of health facilities by type, ownership, size, and interventions offered totaling 175 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time- motion methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Forward-selection stepwise regression methods were used to identify and analyze significant determinants of log-transformed average costs (p<0.1). Results: Results show evidence of economies of scale for all three interventions: doubling the number of clients per year was associated with average cost reductions of 39% for HTC, 49% for PMTCT, and 69% for MC. Moreover, task shifting was associated with reduced costs for both PMTCT (47%) and MC (44%), but not for HTC. Costs in hospitals were higher for both HTC (56%) and PMTCT (60%) in comparison to non-hospitals, but this was not the case for MC. Performance incentives for staff were associated with increased costs in both HTC (50%) and PMTCT (64%), but not in MC. Facilities that performed community- based testing had higher HTC average costs (49%); and lower MC costs were associated with availability of male reproductive health services (81%) and presence of community advisory board (58%). Conclusions: Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision. The extant results have implications for HIV prevention programs in Kenya, and sub-Saharan Africa more generally. 1060 Global Variation in the Impact of Male Circumcision in Preventing HIV Among MSM Lilith K. Whittles 1 ; Kate M. Mitchell 1 ; Romain Silhol 1 ; DobromirT. Dimitrov 2 ; Marie-Claude Boily 1 1 Imperial Coll London, London, UK; 2 Fred Hutchinson Cancer Rsr Cntr, Seattle, WA, USA

Poster Abstracts

Background: The effectiveness of male circumcision (MC) as an HIV prevention measure among heterosexual men has been demonstrated in clinical trials. However, the efficacy and population-level effectiveness of MC among men who have sex with men (MSM) remains uncertain, and is likely to depend on the behavioral and demographic characteristics of specific MSM populations. We assessed the potential impact of MC among MSM in different settings worldwide to help determine the conditions in which it could be an effective HIV prevention measure for MSM.

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CROI 2016