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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)

From: Comparative effectiveness and cost-effectiveness of antiretroviral therapy and pre-exposure prophylaxis for HIV prevention in South Africa

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

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