Q: How would you summarize your study for a lay audience?
For breastfeeding women who have HIV, consistently taking antiretroviral therapy (ART) is essential for their own health and the health of their infants. New long-acting (LA) injectable ART options, such as LA cabotegravir with rilpivirine (CAB/RPV), can help women suppress the HIV virus within their bodies — keeping them healthy and reducing transmission to their infants. Instead of daily oral pills, the injection is received every two months, making it easier for women to sustain treatment during the postpartum period and keep their medical diagnoses private.
Our study focused on Zimbabwe, a country with high maternal HIV prevalence where LA-CAB/RPV is not yet available outside of research settings. We used microsimulation modeling to evaluate the clinical impact and cost-effectiveness of offering this potentially game-changing therapy to postpartum women.
Q: What questions were you investigating?
There were two main questions we set out to answer:
- If long-acting antiretrovirals were made available to breastfeeding women with HIV in Zimbabwe, what clinical impact would it have compared to the status quo of daily oral therapies?
- What is the cost-effectiveness of LA-CAB/RPV, and does this vary based on the level of difficulty women experienced in adhering to oral ART during pregnancy?
Q: What methods or approach did you use?
We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model to simulate how HIV is passed on and how it progresses. This framework enabled us to evaluate the long-term clinical outcomes for a hypothetical group of women and their babies undergoing different treatment strategies — in this case, LA-CAB/RPV versus daily oral ART.
Q: What did you find?
Compared to oral ART, LA-CAB/RPV could prevent up to 160 infant infections per year in Zimbabwe. For women whose HIV has not been fully suppressed by their daily pills at the time of delivery, switching to LA-CAB/RPV could be cost-saving if priced at $156/year or lower. For women whose HIV has already been suppressed at the time of delivery, but who face challenges in adhering to oral ART, switching to LA-CAB/RPV would offer slightly less value, but could be cost-effective if priced at $84/year or lower.
Q: What are the implications?
Long-acting ART formulations hold tremendous promise — especially for people living with HIV who struggle with daily oral regimens, and therefore with viral suppression. We propose that these formulations should be made available globally at an affordable price to ensure they reach the people who may benefit from them most.
Q: What are the next steps?
Looking ahead, we'll build on this important work by evaluating the clinical impact and cost-effectiveness of newer long-acting ART formulations, such as long-acting cabotegravir with lenacapavir, among pregnant and breastfeeding women.
