AEGiS-15IAC: The cost-effectiveness of providing post-exposure prophylaxis to prevent the transmission of HIV after sexual assault in South Africa: Findings and policy implications.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

The cost-effectiveness of providing post-exposure prophylaxis to prevent the transmission of HIV after sexual assault in South Africa: Findings and policy implications.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrC1126)

Christofides NJ, Jewkes RK, Muirhead D, Penn-Kekana LA
Medical Research Council, Pretoria, South Africa

BACKGROUND: Sexual assault and HIV infection are highly prevalent in South Africa. In April 2002 the government announced that post-exposure prophylaxis (PEP) to prevent the transmission of HIV would be made available in the public health service. This study aims to model the cost-effectiveness of PEP to prevent the transmission of HIV after rape.

METHODS: Annual economic costs from a provider perspective per woman covered were calculated from bottom up costing at two sites, one urban and one rural. A cost effectiveness model was developed based on data from these and other services in South Africa. Parameters for the model included the proportion of patients who would be HIV positive on presentation at the health service (data from health services), proportion of perpetrators HIV positive (HSRC population-based data), characteristics of the assault (e.g. multiple perpetrators, trauma) from local research, likelihood of genital ulcerative disease (evidence from Rakai study of seroconversion in discordant consensual sexual relationships), risk of transmission (CDC study on needle stick injury and Rakai study), probability of completion of PEP (health service data) and effectiveness of PEP (estimated from research on needle sticks). Findings: There are 54,000 cases of rape reported annually to the police. It is estimated that 161 cases of HIV (range from sensitivity analysis 54 to 375) could be averted per annum with the implementation of PEP. Incremental cost per HIV transmission averted by introducing PEP as outlined in the national guidelines was estimated in the best case scenario at US$ 5,064 per transmission averted. Sensitivity analysis estimated a mid-level cost of US$ 13,088 and high cost of US$ 42,740 (US$ = 6.5 Rand) per HIV transmission averted. Conclusion Providing PEP may not be the most cost-effective HIV prevention intervention but it is affordable for middle-income countries like South Africa. We need to consider human rights issues and implications for people who have been raped not just costs.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, HIV Infections, Cost-Benefit Analysis, Sex Offenses, Public Policy, AIDS Serodiagnosis, Rape, Needlestick Injuries, South Africa, Humans, Female, transmission, economics, diagnosis

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