OBJECTIVES

This study determined the most cost-effective antiretroviral therapy (ART) used in post-exposure prophylaxis (PEP) in Nigerian Hospitals.

METHODS

A retrospective evaluation of PEP patients’ data was conducted in four tertiary healthcare institutions in Nigeria: Ahmadu Bello University Teaching Hospital (ABUTH), Jos University Teaching Hospital (JUTH), University College Hospital (UCH), and University of Maiduguri Teaching Hospital (UMTH). De-identified data of patients from 2009 to 2016 were obtained from the database of PEPFAR-APIN Centre into Microsoft Excel (2019) for analysis. The effectiveness of the ARTs used was measured as the percentage of HIV infection prevented, while the unit cost for each ART was deduced from the current price list of the donor. Cost-effectiveness analysis was conducted. A Probabilistic Sensitivity Analysis was conducted using Monte Carlo Simulation in1000 iterations. Approval for use of data for the study was obtained from the Institutional Review Boards of Harvard T. H. Chan School of Public Health and APIN Initiative Nigeria.

RESULTS

Five hundred and seventy-five patients accessed PEP treatment in the four centres during the years reviewed: ABUTH (90), JUTH (185), UCH (280), and UMTH (20). Tenofovir (TDF)+Lamivudine (3TC)+Ritonavir-boosted Atazanavir (ATV/r), Zidovudine (AZT)+3TC+ATV/r, AZT+3TC+Ritonavir-boosted Lopinavir (LPV/r), and TDF+3TC+Efavirenz (EFV) were prescribed for 230 (40%), 78 (18.1%), 104 (13.6%), and 55 (9.6%) patients respectively. On completion of the 28-day treatment, 185 (32.2%) patients conducted HIV tests. HIV-negative result was recorded in 129 (69.7%) of the patients tested. The most cost-effective ART was TDF+3TC+EFV, with cost-effectiveness ratio (CER) of N 8.11/HIV infection prevented (95% CI: N 8.052 – N 8.168). TDF + 3TC + LPV/r was the least cost-effective ART, with CER of N 170.66/HIV infection prevented (95% CI: N 169.391 – N 171.925). [$ 1= N 360]

CONCLUSIONS

TDF+3TC+EFV was the most cost-effective PEP regimen used at the PEPFAR/APIN centres in Nigerian teaching hospitals from 2009 to 2016.