Date of Award

January 2020

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

David A. Paltiel

Abstract

HIV/AIDS has been a growing public health concern in China. Although the national prevalence of HIV remains low, the prevalence and incidence rate among certain high-risk groups is rising rapidly, including men who have sex with men (MSM), female sex workers (FSW), and clients of sex workers (CSW). A plethora of evidence have suggested the effectiveness of providing PrEP to high-risk groups, and some Chinese studies also proved that providing PrEP to men who have sex with men is a cost-effective strategy. However, there is no clear evidence about whether intervening on female sex workers and clients of female sex workers is also cost-effective. In this paper, we developed a deterministic compartmental model to simulate the HIV progression and economic outcomes of the PrEP regimen in the next 20 years. Intervention strategies included aiming at one high-risk group at a time and providing PrEP to both MSM & FSW groups. Based on our results, providing PrEP to the MSM group is the most cost-effective strategy among all intervention scenarios, with an average cost-effectiveness ratio of $ 28 thousand per QALY compared to the status quo. While the cost-effectiveness ratio of providing PrEP to both MSM and FSW exceeds the cost-effectiveness boundary, the difference is not large. Only aiming at the CSW group is proved to be expensive, which is hard to be justified only based on cost-effectiveness criteria. As a result, the PrEP regimen can significantly avert new HIV infections in China for the next 20 years if other interventions remained unchanged. In the perspective of cost-effectiveness, MSM is the optimal group to be first targeted at. In addition to the PrEP initiation, efforts on expanding HIV/AIDS testing rate and ART coverage rate are also desirable.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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