| Titre : | Modeling the Impact and Cost-Effectiveness of Pre- Exposure Prophylaxis for HIV Dynamics in Men Who Have Sex with Men in Portugal: A Comparative Study |
| Auteurs : | Boxuan Wang ; Ecole des hautes études en santé publique (EHESP) (Rennes, FRA) |
| Type de document : | Mémoire |
| Année de publication : | 2023 |
| Description : | 40p. |
| Langues: | Anglais |
| Classement : | MPH23/ (Master EHESP International master of public health - MPH) |
| Mots-clés : | Portugal ; Prévalence ; VIH ; Homosexualité ; Augmentation ; Prophylaxie ; Prévention santé ; Analyse coût bénéfice ; Epidémie ; Surveillance épidémiologique ; Etude comparée |
| Résumé : |
Backgrounds: Portugal faces a challenging upward trend of HIV infections among men who have sex with men (MSM). The nation reported a notable 9% annual increase in newly diagnosed HIV cases among MSM from 2005 to 2019, underscoring a stark contrast with the declining rates associated with drug use and heterosexual intercourse, which decreased by 18% and 2% respectively. As traditional prevention and treatment strategies struggle to curb this trend, the role of pre-exposure prophylaxis (PrEP) has emerged as a crucial aspect of a comprehensive response to the epidemic. However, the practicality and effectiveness of PrEP distribution among the MSM population in Portugal remain largely unexplored.
Objectives: (1) Develop an agent-based model to capture of HIV dynamics among MSM in Portugal. (2) Implement a PrEP module in the model, from eligibility identification to uptake. (3) Conduct counterfactual inference to evaluate the efficacy and cost-effectiveness of PrEP under different adherence distribution and PrEP eliglibility policiy strategies. Methods: Using a network-based HIV transmission model, we simulated lifetime costs, qualityadjusted life years (QALYs), and infections averted for different strategies using a health sector perspective. Strategies included a status quo (no interventions), 3 different PrEP adherence level interventions (low, middle, high), and 4 different PrEP eligibility criteria strategies (WHO, US, PNHS and EACS). Cost-effectiveness was evaluated incrementally using a $44,000/QALY gained threshold. Results: The research highlights the significant influence of PrEP adherence levels on HIV prevalence over a 20-year period. Moderate to high adherence levels are vital, reducing HIV prevalence by approximately 31%. High adherence scenarios display a cost of C18,468 per QALY gained, indicating promising cost-effectiveness. On the other hand, low adherence scenarios yield results equivalent to, or worse than, scenarios without PrEP implementation, contributing to a marginal increase in HIV prevalence. Comparing different policy strategies, the US, EACS, and WHO strategies demonstrated greater reductions in HIV prevalence than the PNHS strategy, averting 50%, 40%, and 35% of HIV cases over 20 years, respectively. The cost-effectiveness of these strategies was found to largely depend on the intervention’s duration, with those lasting beyond ten years exhibiting a cost-effectiveness ratio of less than C44,000/QALY gained. Conclusion: Our research underscores the importance of PrEP adherence in controlling HIV among MSM in Portugal, revealing the cost-effectiveness of high adherence scenarios. Different policy strategies such as US, EACS, and WHO demonstrate varying effectiveness and cost-effectiveness. Future research should include overlooked high-risk groups for comprehensive HIV control measures. |
| Diplôme : | Master MPH of public health |
| Plan de classement simplifié : | Master of Public Health - master international de Santé Publique (MPH) |
| En ligne : | https://documentation.ehesp.fr/memoires/2023/mph/boxuan_wang.pdf |
Exemplaires (1)
| Code-barres | Cote | Support | Localisation | Section | Disponibilité |
|---|---|---|---|---|---|
| 096527 | MPH23/0013 | Mémoire | Rennes | Salle Ouessant | Empruntable Disponible |