EPIDEMIOLOGICAL AND ECONOMIC EFFECT OF PREFERENCE-DRIVENHIV PRE-EXPOSURE PROPHYLAXIS IMPLEMENTATION FOR MEN WHOHAVE SEX WITH MEN AND TRANSGENDER WOMEN ACROSS16 COUNTRIES AND TERRITORIES IN THE ASIA-PACIFIC REGION:A MODELLING STUDY...
Author(s)
Shihao He, MPH1, Mingwang Shen, PhD1, Lei Zhang2.
1Xi'an Jiaotong University, Xi'an, China, 2Professor, Monash University, Carlton, Australia.
1Xi'an Jiaotong University, Xi'an, China, 2Professor, Monash University, Carlton, Australia.
OBJECTIVES: We aimed to evaluate the epidemiological and economic effects of implementing preference-driven PrEP among men who have sex with men (MSM) and transgender women.
METHODS: We used preference data from discrete choice experiments conducted in 16 Asia-Pacific countries and territories between May and November 2022, covering MSM at substantial risk, men who have sex with men at low risk, and transgender women. Preferences were assessed for daily oral, on-demand, and long-acting injectable PrEP. A mathematical model translated stated preferences into willingness to use PrEP and projected coverage. We estimated annual HIV acquisitions averted and cost per acquisition averted for three single-modality and one mixed-modality PrEP strategies compared with baseline coverage.
RESULTS: Estimated willingness to use PrEP ranged from 46·8% for on-demand PrEP among MSM at low risk in Nepal to 95·2% for mixed-modality PrEP among transgender women in Laos. Estimated PrEP coverage ranged from 10·8% to 30·8%. Long-acting injectable PrEP produced the largest reductions in annual HIV acquisitions, ranging from 17·1% among transgender women in Cambodia to 32·2% among MSM at substantial risk in Australia. Median cost per acquisition averted was lowest for on-demand PrEP, ranging from US$2302 among transgender women in Viet Nam to US$742,727 among MSM at low risk in Japan. Median cost per acquisition averted was highest for long-acting injectable PrEP, ranging from US$21,132 among transgender women in India to US$10,315,297 among MSM at low risk in Japan. Once HIV incidence exceeded the critical turning point, the cost per acquisition averted decreased sharply.
CONCLUSIONS: Implementation of preference-driven PrEP strategies could substantially reduce HIV acquisitions among men who have sex with men and transgender women in the Asia-Pacific region. Long-acting injectable PrEP offered the greatest epidemiological effect but at the highest cost, whereas on-demand PrEP was the most economically efficient modality.
METHODS: We used preference data from discrete choice experiments conducted in 16 Asia-Pacific countries and territories between May and November 2022, covering MSM at substantial risk, men who have sex with men at low risk, and transgender women. Preferences were assessed for daily oral, on-demand, and long-acting injectable PrEP. A mathematical model translated stated preferences into willingness to use PrEP and projected coverage. We estimated annual HIV acquisitions averted and cost per acquisition averted for three single-modality and one mixed-modality PrEP strategies compared with baseline coverage.
RESULTS: Estimated willingness to use PrEP ranged from 46·8% for on-demand PrEP among MSM at low risk in Nepal to 95·2% for mixed-modality PrEP among transgender women in Laos. Estimated PrEP coverage ranged from 10·8% to 30·8%. Long-acting injectable PrEP produced the largest reductions in annual HIV acquisitions, ranging from 17·1% among transgender women in Cambodia to 32·2% among MSM at substantial risk in Australia. Median cost per acquisition averted was lowest for on-demand PrEP, ranging from US$2302 among transgender women in Viet Nam to US$742,727 among MSM at low risk in Japan. Median cost per acquisition averted was highest for long-acting injectable PrEP, ranging from US$21,132 among transgender women in India to US$10,315,297 among MSM at low risk in Japan. Once HIV incidence exceeded the critical turning point, the cost per acquisition averted decreased sharply.
CONCLUSIONS: Implementation of preference-driven PrEP strategies could substantially reduce HIV acquisitions among men who have sex with men and transgender women in the Asia-Pacific region. Long-acting injectable PrEP offered the greatest epidemiological effect but at the highest cost, whereas on-demand PrEP was the most economically efficient modality.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EPH4
Topic
Epidemiology & Public Health
Disease
SDC: Infectious Disease (non-vaccine), SDC: Reproductive & Sexual Health