Cost-effectiveness of HIV Prevention Interventions: Estimates from Real-world Implementation Needed

Abstract

tions challenging if modeled differently. This challenge is particularly acute for decision-makers faced with budget prioritization decisions. Despite important reductions in HIV-1 incidence in sub-Saharan Africa over thepast decade, current projections suggest that UNAIDS epidemic control targets for 2020 will not be met [1]. The rapidly expanding toolkit of HIV-1 prevention methods – including risk and harm reduction interventions, voluntary medical male circumcision (VMMC), and antiretrovirals for treatment as prevention (TasP), prevention of mother-to-child transmission (PMTCT), and pre-exposure prophylaxis (PrEP) – arguably contains the components necessary, when delivered in combination, to curtail the epidemic substantially. However, the expansion of available HIV-1 prevention methods runs parallel to stagnating donor budgets and limited national resources to implement such methods [2]. Optimal allocation of these highlyeffective methods will be key to meeting new epidemic control targets for 2030 [3]. Cost-effectiveness analyses provide a critical tool to evaluate how limited resources can best be deployed tomaximize HIV-1 prevention impact. In this issue of EClinicalMedicine, Sarkar et al. [4] provide valuable insight to the current understanding of the relative costs and costeffectiveness of available HIV-1 prevention methods in sub-Saharan Africa with their systematic review comprising 60 articles across 14 countries. This collection of studies demonstrates consistency of costeffectiveness estimates across settings andmodel assumptions for interventions that are currently widely implemented, including VMMC and PMTCT, thereby supporting global policy recommendations in favor of these interventions and providing important information for advocacy groups. This review also highlights that implementation strategies that