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. 2015 Jul 20;18(4 Suppl 3):19946.
doi: 10.7448/IAS.18.4.19946. eCollection 2015.

Seasonal PrEP for partners of migrant miners in southern Mozambique: a highly focused PrEP intervention

Ide Cremin  1 , Fernando Morales  2 , Britta L Jewell  3 , Kevin R O'Reilly  4 , Timothy B Hallett  3
Affiliations

Seasonal PrEP for partners of migrant miners in southern Mozambique: a highly focused PrEP intervention

Ide Cremin et al. J Int AIDS Soc. .

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] J Int AIDS Soc. 2016 Feb 17;19(1):20948. doi: 10.7448/IAS.19.1.20948. eCollection 2016. J Int AIDS Soc. 2016. PMID: 26905056 Free PMC article. No abstract available.

Abstract

Introduction: To be used most effectively, pre-exposure prophylaxis (PrEP) should be prioritized to those at high risk of acquisition and would ideally be aligned with time periods of increased exposure. Identifying such time periods is not always straightforward, however. Gaza Province in southern Mozambique is characterized by high levels of HIV transmission and circular labour migration to mines in South Africa. A strong seasonal pattern in births is observable, reflecting an increase in conception in December. Given the potential for increased HIV transmission between miners returning in December and their partners in Gaza Province, PrEP use by the latter would be a useful means of HIV prevention, especially for couples who wish to conceive.

Methods: A mathematical model was used to represent population-level adult heterosexual HIV transmission in Gaza Province. Increased HIV acquisition among partners of miners in December, coinciding with the miners' return from South Africa, is represented. In addition to a PrEP intervention, the scale-up of treatment and recent scale-up of male circumcision that have occurred in Gaza are represented.

Results: Providing time-limited PrEP to the partners of migrant miners, as opposed to providing PrEP all year, would improve the cost per infection averted by 7.5-fold. For the cost per infection averted to be below US$3000, at least 85% of PrEP users would need to be good adherers and PrEP would need to be cheaper than US$115 per person per year. Uncertainty regarding incidence of HIV transmission among partners of miners each year in December has a strong influence on estimates of cost per infection averted.

Conclusions: Providing time-limited PrEP to partners of migrant miners in Gaza Province during periods of increased exposure would be a novel strategy for providing PrEP. This strategy would allow for a better prioritized intervention, with the potential to improve the efficiency of a PrEP intervention considerably, as well as providing important reproductive health benefits.

Keywords: ARV-based prevention; HIV; cost-effectiveness; mathematical models; pre-exposure prophylaxis.

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Figures

Figure 1
Figure 1
The reported number of institutional births each month in Gaza Province and Cabo Delgado Province, Mozambique.
Figure 2
Figure 2
Modelled prevalence and incidence. Model calibration to prevalence (a); modelled incidence among men and women (b); modelled incidence among partners of miners (c).
Figure 3
Figure 3
The influence of prioritizing PrEP on the estimated cost per infection averted.
Figure 4
Figure 4
The (a) influence of adherence on impact and (b) influence of adherence and cost on cost per infection averted.
Figure 5
Figure 5
The influence of different assumptions regarding the level of transmission occurring between miners and their partners in December.
See this image and copyright information in PMC

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