Pre-exposure Prophylaxis and Antiretroviral Therapy for HIV Prevention in South Africa which is the Best Use of Resources

ABSTRACT

An estimated 1.6 million new HIV infections occurred in 2012 in sub-Saharan Africa (1); highlighting the need for continued investments in HIV treatment and prevention efforts. With an HIV prevalence of about 18; South Africa (RSA) remains a particularly affected country; despite sustained investments in HIV control programs such as expansion of antiretroviral therapy (ART). In recent years; scientific innovations in HIV control have expanded the range of available interventions - male circumcision; topical microbicides; oral pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) have all sparked significant interest due to their potential effectiveness (ART reduces HIV transmission by up to 96; PrEP by more than 60) and versatility (circumcision is effective without additional actions required from the person; PrEP is meant for use by uninfected individuals; ART is given to infected individuals). While all these options are potentially available; resources remain limited and choosing which interventions to implement at scale is a difficult task; given the complex nature of disease transmission; the impact of behaviour in epidemic dynamics (number of partners; rates of condom use; adherence to treatment/prevention regimens); and the different costs of these programs