{'fraction_non_alphanumeric': 0.047566976489885185, 'fraction_numerical': 0.02733734281027884, 'mean_word_length': 4.630769230769231, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 1, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The Cost-effectiveness of HIV Pre-exposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India.

BACKGROUND
The HIV epidemic in India is concentrated in 3.1M men who have sex with men (MSM) and 1.1M people who inject drugs (PWID), with mean incidence 0.9-1.4/100 person-years. We examined the cost-effectiveness of both pre-exposure prophylaxis (PrEP) and HIV testing strategies at different frequencies for MSM and PWID in India.


METHODS
We populated an HIV microsimulation model with India-specific data and examined seven strategies for MSM/PWID, including: status quo; one-time HIV test at model onset; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 months (the WHO-recommended monitoring frequency) or every 6 months. We projected clinical and economic outcomes for MSM and PWID who are HIV-uninfected or infected but undetected. We used a willingness-to-pay threshold of US$1,950, the 2017 Indian per capita GDP, to define cost-effectiveness.


RESULTS
HIV testing alone increased life expectancy by 0.07-0.30 years in MSM; PrEP added ~0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (ICER=$1,000/YLS) and PWID (ICER=$500/YLS) and reduced lifetime HIV risk. Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708M (MSM) and US$218M (PWID) over 5 years compared to status quo.


CONCLUSIONS
While the WHO recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semi-annual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.