Garnett Geoffrey Peter, Godfrey-Faussett Peter
TB & HIV Team, Gates Foundation, Seattle, Washington, USA.
LSHTM, London, UK.
J Int AIDS Soc. 2025 Jun;28 Suppl 1(Suppl 1):e26455. doi: 10.1002/jia2.26455.
Post-exposure prophylaxis (PEP) is an efficacious HIV prevention tool when used soon after a potential exposure. Understanding the drivers of cost-effectiveness of PEP in different contexts will likely play a role in determining local policies for providing PEP.
The cost-effectiveness of PEP depends upon the likelihood of exposure to HIV, the transmission probability per sexual act and the efficacy of PEP, along with associated costs. The transmission probability per sex act will be greater in the first few acts in a partnership than on average across all acts owing to heterogeneity in the transmission probability between partnerships. In settings with high HIV prevalence and low treatment coverage, appropriately focused PEP is cost-saving. As treatment coverage improves, PEP can remain cost-effective with HIV prevalences above 15% with treatment coverage achieving 90:90:90 treatment targets. At 95:95:95 treatment levels, it is unlikely to be cost-effective. PEP is only cost-effective for the first few sex acts within a partnership. The cost-effectiveness of PEP is sensitive to assumptions about the proportion of the population of partners with unsuppressed HIV, the pattern of mixing of those with unsuppressed virus, the transmission probability per sexual act, PEP efficacy, the costs of PEP and the value attached to preventing HIV acquisition. Where possible local parameters should be used in evaluating PEP cost-effectiveness in our model.
We illustrate the use of simple calculations to define the cost-effectiveness of PEP. In populations where there is a high prevalence of unsuppressed HIV, PEP is likely to be cost-effective but only if used for one off sexual encounters and the first few sex acts within a partnership.
暴露后预防（PEP）在潜在暴露后尽快使用时是一种有效的艾滋病毒预防工具。了解不同背景下PEP成本效益的驱动因素可能会在确定提供PEP的地方政策中发挥作用。
PEP的成本效益取决于感染艾滋病毒的可能性、每次性行为的传播概率、PEP的疗效以及相关成本。由于不同伴侣之间传播概率的异质性，伴侣关系中最初几次性行为的每次性行为传播概率将高于所有性行为的平均水平。在艾滋病毒高流行率和低治疗覆盖率的环境中，适当针对性的PEP具有成本节约效益。随着治疗覆盖率的提高，当艾滋病毒流行率高于15%且治疗覆盖率达到90:90:90治疗目标时，PEP仍可具有成本效益。在95:95:95治疗水平下，它不太可能具有成本效益。PEP仅在伴侣关系中的最初几次性行为中具有成本效益。PEP的成本效益对以下假设敏感：未抑制艾滋病毒的伴侣人群比例、未抑制病毒者的混合模式、每次性行为的传播概率、PEP疗效、PEP成本以及预防艾滋病毒感染的价值。在评估我们模型中PEP的成本效益时，应尽可能使用当地参数。
我们说明了使用简单计算来定义PEP的成本效益。在未抑制艾滋病毒高流行的人群中，PEP可能具有成本效益，但前提是仅用于一次性接触以及伴侣关系中的最初几次性行为。
