Background: The development of antiretroviral-based HIV prevention products has substantially changed the prevention landscape. A promising area of research is the development of candidate multipurpose prevention technologies (MPTs), products which could offer users protection from HIV, other STIs, or unintended pregnancy. We estimate the cost-effectiveness of a range of potential single- and multi-purpose prevention products.
Methods: We combine a cost model with a simple, static model of product impact to estimate the cost-effectiveness of five MPTs - oral PrEP, intravaginal rings, injectable ARVs, microbicide gels, and SILCS diaphragms used in concert with gel. We account for the preferences of end-users by predicting uptake using a discrete choice experiment (DCE) among 362 general population women (HIV negative, aged 16-45) and 122 female sex workers (FSW) (HIV negative, aged 18-45) in South Africa. DCE results were also used to predict additional uptake for products offering contraceptive properties. Disability-adjusted life years (DALYs) averted per HIV infection were estimated for each group under scenarios of low, median and high HIV incidence as observed in recent trials. The model incorporated costs relating to local and national implementation and MPT development, whilst averted costs included those related to treatment and the avoidance of unintended pregnancies. A sensitivity analysis explores the robustness of estimates to parameter uncertainty.
Results: On average, the cost-effectiveness of MPTs was around 35% better than single-purpose products. All rollout scenarios were cost-effective using a 1xGDP threshold, but only interventions among young women (< 25 years) and FSWs were cost-effective when lower, more methodologically robust thresholds were applied.


Conclusions: Candidate MPTs are attractive to both women in the general population, and female sex workers. Incorporating contraceptive indications into HIV prevention products could increase product uptake, impact, and improve cost-effectiveness. This study provides further impetus for the development of effective and attractive MPTs.