CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: Using PrEP as a bridging strategy in discordant couples until the HIV-positive partner is on ART for 6 months may cost-effectively combine the preventive benefit of PrEP with the therapeutic benefit of ART until the HIV-positive partner is virally suppressed. 1107 Multipurpose Prevention Technologies for HIV and Pregnancy Prevention Rebecca Geary; Jennifer Smith ; Nidhi Khurana; Ide Cremin;Timothy Hallett Imperial College London, London, United Kingdom Background: Multipurpose prevention technologies (MPTs) to prevent both HIV and unintended pregnancy could create important opportunities in terms of cost efficiencies, higher acceptability (compared to HIV-prevention only products) and a reduced adherence burden for users. Women with unmet need for dual protection against unintended pregnancy and HIV infection are a priority for prevention interventions. MPTs could add to the limited number of much-needed female-controlled HIV prevention methods and increase contraceptive method choice. Their potential impact and cost-effectiveness has not been fully analysed. Methods: We modeled the introduction of an MPT vaginal ring in South Africa and examined HIV and reproductive health outcomes. We assumed a range of efficacy estimates for HIV prevention (60-80%) and pregnancy (92-97%), and different delivery strategies (horizontal and vertical, prioritising up to 10% of different age and risk groups). We examined the health impact and estimated the cost-effectiveness for the introduction of the MPT relative to existing prevention measures per HIV incident infection and disability adjusted life year (DALY) averted. Results: The MPT could avert 1.6-2.9% of new HIV infections among women aged 15-49 years, 4.3-4.6% of maternal deaths and 1.5-1.6% of DALYS among women aged 15-49 years that would occur between 2018 and 2025 using a delivery strategy that targets 10% of 15-29 year-olds and 5% of 30-49 year-olds. The majority of DALYS averted are derived from reproductive health outcomes, primarily due to the reduction in maternal deaths. The influence of the chosen delivery strategy outweighs variations in product efficacy in terms of the MPT impact on health. A multipurpose intra-vaginal ring could be very cost-effective ($200 to $2,700 per DALY averted) when delivered through either horizontal or vertical programmes. Conclusions: The use of MPTs could substantially and cost-effectively generate health among women in South Africa. However the success of MPTs, with regard to both impact and cost effectiveness, will be determined by the delivery strategy of a product rather than its efficacy and cost. We urge for operational studies to be conducted to evaluate the feasibility of potential delivery strategies of MPTs for women. New and forthcoming data on the MPT delivery costs and women’s preferences will be critical for determining their use across different settings. 1108 Cost-Effectiveness of Isoniazid Preventative Therapy for HIV-Infected Pregnant Women in India Background: Pregnancy increases the risk of active Tuberculosis (TB) infection particularly in HIV-infected women. Co-infection can result in increased morbidity and mortality for both mother and child. Isoniazid preventative therapy (IPT) may reduce progression to active TB in HIV-infected individuals, but confers risks of drug toxicity in pregnant women and added costs. Globally, India has both the highest number of incident TB cases and a high burden of HIV. The epidemiology of this co-infection in India differs substantially from that of other high HIV and TB burden countries like South Africa. The cost-effectiveness of IPT for HIV-infected pregnant women in India is unknown. Methods: An economic evaluation from the health-system perspective was performed using a decision analytic model to determine the cost-effectiveness of antepartum IPT among HIV-infected pregnant women (all assumed to be on anti-retroviral therapy) in India. We compared two antepartum TB preventative strategies with the current practices in India (no IPT): Intervention 1 (6 months IPT for all HIV-infected women regardless of CD4 cell count) and Intervention 2 (6 months IPT for HIV-infected pregnant women with CD4 cell counts ≤ 200 cells/ m l). Primary outcomes were anticipated costs, disability-adjusted life years (DALYs), active TB cases, and TB related deaths. Cost-effectiveness was represented using incremental cost-effectiveness ratios (ICERs). Results: Both interventions (1) IPT for all HIV-infected pregnant women and (2) IPT only for those women with CD4 cell counts ≤ 200 cells/ m l were found to improve health outcomes compared to no IPT. Intervention 1 resulted in the greatest improvement in health outcomes with 21 active TB cases averted per 1000 patients and 10 active TB deaths averted per 1000 patients at an incremental cost of $20.26 per individual. Intervention 2 also showed improved health outcomes with 3 active TB cases averted per 1000 patients Sunaina Kapoor; Natasha Chida; Amita Gupta; Maunank Shah Johns Hopkins University School of Medicine, Baltimore, MD, US

Poster Abstracts

643

CROI 2015