{"doi":"10.1002/jia2.26427","title":"Cost thresholds for anticipated long‐acting HIV pre‐exposure prophylaxis products in Eastern and Southern Africa: a mathematical modelling study","abstract":"INTRODUCTION: Affordable HIV prevention tools are needed in Eastern and Southern Africa (ESA). Several promising long-acting pre-exposure prophylaxis (LA-PrEP) products are available or in development. However, ESA settings face severe healthcare resource constraints. We aimed to estimate the threshold price at which LA-PrEP products could be cost-effective in three ESA settings. METHODS: We adapted an agent-based model, EMOD-HIV, to simulate LA-PrEP (monthly oral, 2- and 6-monthly injectable) rollout in South Africa, Zimbabwe and Kenya. Due to uncertainties about LA-PrEP use, we examined a range of coverages (5%-20% of HIV-negative sexually active adults) and extents to which LA-PrEP use will be concentrated among those most at risk (prioritized rollout from higher- to lower-risk groups vs. uniform rollout among sexually active adults). To evaluate a 20-year commitment to LA-PrEP delivery, we assumed LA-PrEP was scaled up to target coverage from 2025 to 2030 and maintained at target levels before ending in 2045. We estimated maximum per-dose and per-year LA-PrEP costs that achieve cost-effectiveness (<US$500 per disability-adjusted life-year averted) over 35 years (until 2060), compared to a scenario of daily oral PrEP only. Sensitivity analyses varied PrEP scale-up speeds and eligible populations. RESULTS: Risk-prioritized LA-PrEP for 5% of adults was projected to avert 11-21% of HIV acquisitions across settings, with 3-5 times more HIV acquisitions averted and 3-5 times higher maximum cost compared to non-prioritized rollout. Six-monthly injectable PrEP supported the highest per-dose cost: in the scenario with the most cost-effective LA-PrEP use (5% risk-prioritized rollout), the maximum per-dose price in South Africa was $52.99 (95% CI: $48.82-$57.21), in Zimbabwe $14.64 (95% CI: $12.04-$17.38) and in western Kenya $7.50 (95% CI: $6.73-$8.27). For monthly oral PrEP, corresponding per-dose costs were $5.02 (95% CI: $4.67-$5.37), $1.45 (95% CI: $1.10-$1.79) and $0.87 (95% CI: $0.80-$0.93). Results were sensitive to eligible population and prioritization, and moderately sensitive to scale-up speed and product effectiveness. CONCLUSIONS: LA-PrEP is likely to require reduced pricing and/or risk-prioritized rollout to be cost-effective in ESA.","journal":"Journal of the International AIDS Society","year":2025,"id":512794,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9458,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":289068,"name":"Monisha Sharma","orcid":"0000-0002-7599-1561","position":1,"is_corresponding":false},{"id":955826,"name":"Danielle Resar","orcid":"0009-0006-3865-9523","position":2,"is_corresponding":false},{"id":890877,"name":"Masabho Milali","orcid":null,"position":3,"is_corresponding":false},{"id":490089,"name":"Edinah Mudimu","orcid":"0000-0002-5479-9255","position":4,"is_corresponding":false},{"id":1093258,"name":"Linxuan Wu","orcid":"0009-0006-7240-5412","position":5,"is_corresponding":false},{"id":517663,"name":"Cory Arrouzet","orcid":"0000-0002-7470-3927","position":6,"is_corresponding":false},{"id":665347,"name":"Ingrida Platais","orcid":"0000-0001-5609-5393","position":7,"is_corresponding":false},{"id":393192,"name":"Hae‐Young Kim","orcid":"0000-0002-5124-1555","position":8,"is_corresponding":false},{"id":1372993,"name":"Sarah Yardly Jenkins","orcid":"0000-0001-5667-095X","position":9,"is_corresponding":false},{"id":490091,"name":"Anna Bershteyn","orcid":"0000-0002-6604-7093","position":10,"is_corresponding":false},{"id":1363185,"name":"David Kaftan","orcid":"0000-0002-0771-1353","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":null,"created_at":"2026-07-19T02:48:11.233009Z","pmid":"39995017","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}