TITLE: A Portfolio Approach to HIV Control in South Africa

SPEAKER:  Elisa Long

ABSTRACT:

Recent HIV studies have stimulated interest in implementing portfolios of partially effective programs.  Using a dynamic HIV epidemic model, we evaluate population-level health benefits and costs of alternative portfolios, given uncertainty in each program’s effectiveness at reducing transmission.  We determine the optimal allocation of resources to each intervention, given a budget constraint.  Using a Monte Carlo simulation, we perform a probabilistic sensitivity analysis on the effectiveness of each intervention, based on the sampling distribution obtained in each clinical trial.  We find that a comprehensive portfolio of expanded screening, antiretroviral treatment, male circumcision, tenofovir microbicide gel, and preventive vaccination could avert 2.3 million HIV cases in South Africa over 10 years, a 66% reduction in incidence.  This strategy doubles treatment initiation, decreases adult HIV prevalence from 18% to <10%, and adds 32 million quality-adjusted life years (QALYs), at a cost of $29 billion over 10 years (or approximately $100 per person per year).  The incremental cost-effectiveness is <$2,000 per QALY gained, assuming reasonable microbicide and vaccine costs.  A portfolio of modestly effective prevention programs could substantially reduce HIV incidence in South Africa, and is an economically efficient use of limited resources.