{"doi":"10.1016/j.eclinm.2020.100453","title":"Modeling the health impact and cost threshold of long-acting ART for adolescents and young adults in Kenya","abstract":"BACKGROUND: Despite high efficacy of oral antiretroviral therapy (ART), viral suppression among adolescents and young adults (AYA) living with HIV in sub-Saharan Africa (SSA) remains low. Compared to daily oral ART, bimonthly long-acting injectable ART (LA-ART) may simplify adherence, improve clinical outcomes, and decrease HIV transmission in this priority population. However, LA-ART will likely cost more than oral ART and the cost threshold at which LA-ART will be cost effective in SSA has not been evaluated. METHODS: We adapted a mathematical model of HIV transmission and progression in Kenya to include HIV acquisition and viral suppression among AYA (age 10-24). We projected the population-level health and economic impact of providing LA-ART to AYA over a 10-year time horizon assuming oral ART costs of US$233 annually and a two-month duration of viral suppression per LA-ART injection. We calculated the maximum cost at which switching from oral to LA-ART would be considered cost-effective, using thresholds of $500 and $1,508 per disability-adjusted life year averted (WHO's threshold of HIV treatment interventions and Kenya's gross domestic product per capita). FINDINGS: Assuming 85% of AYA switch from oral to injectable formulations, LA-ART is estimated to prevent 40,540 infections and 20,480 deaths over 10 years. The maximum increase in the annual per-person cost of receiving LA-ART is estimated to be $89 and $236 for LA-ART to be cost-effective under the thresholds of $500 and $1,508 per DALY averted, respectively. The cost threshold was lower when non-adherent oral ART AYA users were assumed to be less likely to switch to LA-ART. INTERPRETATION: Providing LA-ART to AYA can be cost-effective in Kenya if it is less than twice the cost of oral ART. Long-acting injectable ART for priority populations with low viral suppression has the potential to cost-effectively avert disability and death. FUNDING: National Institutes of Health (R01 HD085807; PI: Kohler).","journal":"EClinicalMedicine","year":2020,"id":102445,"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":26,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9484,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","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":499900,"name":"Kate Wilson","orcid":"0000-0003-1886-4280","position":2,"is_corresponding":false},{"id":315399,"name":"D. Allen Roberts","orcid":"0000-0003-3660-6330","position":3,"is_corresponding":false},{"id":376364,"name":"Cyrus Mugo","orcid":"0000-0001-7516-2168","position":4,"is_corresponding":false},{"id":376369,"name":"Dalton Wamalwa","orcid":"0000-0002-5510-462X","position":5,"is_corresponding":false},{"id":376367,"name":"Irene Inwani","orcid":"0000-0002-4912-1028","position":6,"is_corresponding":false},{"id":315406,"name":"Ruanne V. Barnabas","orcid":"0000-0002-1793-6003","position":7,"is_corresponding":false},{"id":413270,"name":"Pamela Kohler","orcid":"0000-0001-6176-6374","position":8,"is_corresponding":false},{"id":500456,"name":"Jessica E. Culhane","orcid":"0009-0008-8441-6703","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-18T22:40:51.552773Z","pmid":"32954235","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":[]}