Loading
Life sciences · Journal article
The Lancet. Global Health
Encouraging direction, but not yet definitive.
This health economic model projects that scaled online PrEP and PEP provision in western Kenya would be cost-effective from the Kenya Ministry of Health perspective (ICER $212 per DALY averted, well below the $500 threshold) and avert 13.9% of HIV infections over 10 years despite low population coverage of 0.7% for PEP and 0.3% for PrEP. The findings are contingent on simulation assumptions and pilot-derived parameters; real-world implementation effectiveness remains untested.
Health economic modelling study (network-based simulation). Eligible clients aged 15–49 years reporting condomless sex with non-marital partners; parameters informed by ePrEP Kenya pilot in Nairobi and Mombasa.. Intervention: Online pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) provision via public-private partnership; Kenya Ministry of Health provides drugs and service delivery costs charged to clients.. Compared with: Baseline scenario of background oral PrEP only (no online PrEP/PEP scale-up).. Western Kenya; model parameterised using ePrEP Kenya pilot data from Nairobi and Mombasa..
Online PrEP and PEP projected population coverage 0·7% (95% UI 0·7–0·8) for PEP and 0·3% (0·2–0·3) for PrEP 13·9% (95% UI 10·1–17·1) of HIV infections averted over 10 years HIV-related deaths reduced by 4·3% (95% UI 2·0–6·9) over 35-year time horizon
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
The findings suggest that public-private partnerships leveraging online pharmacies could extend HIV prevention reach cost-effectively in resource-limited settings. However, clinicians and programme managers should note that this is a projection; real-world coverage, uptake, adherence, and health outcomes depend on implementation fidelity, client acceptance, and integration with existing HIV services.
Modelling study projecting cost-effectiveness of online PrEP/PEP in western Kenya with favourable ICER under local threshold, but evidence strength limited by reliance on simulation, pilot data, and absence of real-world implementation outcomes.
As stated by the source record.
Quoted from the source exactly as published.
The findings suggest that public-private partnerships leveraging online pharmacies could extend HIV prevention reach cost-effectively in resource-limited settings. However, clinicians and programme managers should note that this is a projection; real-world coverage, uptake, adherence, and health outcomes depend on implementation fidelity, client acceptance, and integration with existing HIV services.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Oral pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) provision via online pharmacies (henceforth online PrEP and PEP) offers promise in increasing biomedical HIV prevention coverage. In this study, we aimed to estimate the cost-effectiveness of online PrEP and PEP scale-up in western Kenya.Methods. We adapted a network-based model, EMOD-HIV, to simulate online PrEP and PEP implementation from 2026 to 2036; costs and use of online PrEP and PEP and client characteristics were informed by the ePrEP Kenya pilot study, which evaluated online PrEP and PEP provision in Nairobi and Mombasa, Kenya. Other parameters were obtained from surveillance data and published literature. Eligible clients were aged 15-49 years reporting condomless sex with non-marital partners. We assumed online PrEP and PEP provision was implemented through public-private partnership, with the Kenya Ministry of Health providing PrEP and PEP drugs and service delivery costs paid by the online pharmacy (and charged to clients). We estimated HIV infections, HIV-related deaths, and disability-adjusted life-years (DALYs) averted compared with the baseline scenario of background oral PrEP only. We calculated incremental cost-effectiveness ratios (ICERs) assessing only costs incurred by the Kenya Ministry of Health over 35 years and used a supply-side threshold of US$500 per DALY averted. We calculated 95% uncertainty intervals (UIs) across 100 parameter sets.Findings. Online PrEP and PEP was projected to reach population coverage of 0·7% (95% UI 0·7-0·8) for PEP and 0·3% (0·2-0·3) for PrEP and avert 13·9% (10·1-17·1) of HIV infections over 10 years. HIV-related deaths were reduced by 4·3% (95% UI 2·0-6·9) over the 35-year time horizon. The intervention was cost-effective from the Kenya Ministry of Health perspective (ICER $212 [95% UI 15-1409] per DALY averted). In a scenario assuming only online PEP availability (to isolate the effect of PEP), 11·6% (95% UI 8·6-15·2) of HIV infections were averted (ICER $210 [95% UI 41-3798] per DALY averted). The intervention remained cost-effective when varying PrEP and PEP effectiveness and assuming HIV testing and treatment disruptions.Interpretation. Online PrEP and PEP can avert substantial HIV infections, even with low population coverage. PEP was responsible for most intervention health benefits, likely due to high observed demand for PEP compared with PrEP in the pilot study. Leveraging private retailers can be efficient for scaling up HIV prevention in an era of shrinking donor funding.Funding. Gates Foundation.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.