MODELING THE IMPACT OF SCALE-UP OF LONG-ACTING INJECTABLE PRE-EXPOSURE PROPHYLAXIS (LAI PREP) FOR HIV PREVENTION INBRAZIL: A HIGH-IMPACT INVESTMENT IN HIV PREVENTION
Author(s)
Thomas M. Bendall, BSc, MBA, MSc1, Rafael Aguiar Maciel, MSc2, Magda Araujo, MSc2, Rob Blissett, Eng.D3, Johan Klint, PhD3, Jon Tosh, BA, MSc, PhD1, Melanie Schroeder, BSc, MSc1, Sarah-Jane Anderson, BA, MSc, PhD1, Jeremy Fraysse, MSc4, Julie Priest, MSPH4.
1ViiV Healthcare, London, United Kingdom, 2GSK, Rio de Janeiro, Brazil, 3Maple Health Group, New York, NY, USA, 4ViiV Healthcare, Durham, NC, USA.
1ViiV Healthcare, London, United Kingdom, 2GSK, Rio de Janeiro, Brazil, 3Maple Health Group, New York, NY, USA, 4ViiV Healthcare, Durham, NC, USA.
OBJECTIVES: Brazil has committed to the UNAIDS 95-95-95 targets and ending HIV/AIDS as a public health threat by 2030. Despite progress new HIV acquisitions represent a significant public health and economic burden. While oral PrEP is available through the public health system, barriers limit uptake and persistence. Expanding the range of HIV prevention options, including LAI PrEP, may better address the diverse needs of populations at risk. This study aimed to estimate the epidemiological impact and return on investment (ROI) for scale-up of LAI PrEP above the current oral PrEP provision in Brazil.
METHODS: We adapted a published compartmental dynamic HIV transmission model by calibrating to Brazilian surveillance data reported by the Ministério da Saúde. The model stratified the adult (15+) population by acquisition risk and represented people with HIV across the care continuum. We compared incidence and prevalence between 2024 and 2034 when use of oral PrEP is maintained (~11.05% of 1,000,000 eligible individuals in 2024) with a scenario of LAI PrEP scale-up of 20% in addition to oral PrEP, totalling ~31.05% of eligible individuals using PrEP by 2027. ROI was calculated as lifetime costs savings for averted acquisitions relative to additional prevention costs with LAI PrEP scale-up (Using list prices for PrEP intervention costs).
RESULTS: By 2034, projected new acquisitions with LAI PrEP scale-up saw 186,860 fewer infections (36.4% reduction), decreasing towards elimination targets and prevalence plateauing. Cumulative averted lifetime care costs exceeded additional prevention costs in all years; scaling LAI PrEP is associated with a positive long-term ROI, with a gross return of R$2.82 for each R$1 invested expected by 2034.
CONCLUSIONS: Scale-up of LAI PrEP could support meaningful progress towards HIV transmission targets while yielding a positive long-term ROI. Expanding access to differentiated prevention options may help improve PrEP uptake and persistence among populations at risk of HIV acquisition.
METHODS: We adapted a published compartmental dynamic HIV transmission model by calibrating to Brazilian surveillance data reported by the Ministério da Saúde. The model stratified the adult (15+) population by acquisition risk and represented people with HIV across the care continuum. We compared incidence and prevalence between 2024 and 2034 when use of oral PrEP is maintained (~11.05% of 1,000,000 eligible individuals in 2024) with a scenario of LAI PrEP scale-up of 20% in addition to oral PrEP, totalling ~31.05% of eligible individuals using PrEP by 2027. ROI was calculated as lifetime costs savings for averted acquisitions relative to additional prevention costs with LAI PrEP scale-up (Using list prices for PrEP intervention costs).
RESULTS: By 2034, projected new acquisitions with LAI PrEP scale-up saw 186,860 fewer infections (36.4% reduction), decreasing towards elimination targets and prevalence plateauing. Cumulative averted lifetime care costs exceeded additional prevention costs in all years; scaling LAI PrEP is associated with a positive long-term ROI, with a gross return of R$2.82 for each R$1 invested expected by 2034.
CONCLUSIONS: Scale-up of LAI PrEP could support meaningful progress towards HIV transmission targets while yielding a positive long-term ROI. Expanding access to differentiated prevention options may help improve PrEP uptake and persistence among populations at risk of HIV acquisition.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH224
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
Infectious Disease (non-vaccine), Reproductive & Sexual Health