Cost-effectiveness of HIV prevention interventions in sub-Saharan Africa (2019-2025): a systematic review.

Introduction: This systematic review synthesizes recent evidence on the cost-effectiveness of HIV prevention interventions in sub-Saharan Africa (SSA), where over 70% of the global HIV burden resides.

Methods: Following PRISMA 2020 guidelines, we searched five databases (2019-2025) for full economic evaluations of HIV prevention in SSA. Studies were assessed using CHEERS 2022 and Drummond checklists. Costs were adjusted to 2024 USD and compared to GDP per capita thresholds. Results were synthesized narratively.

Results: 30 studies were included; 28 used model-based designs, 2 used trial or cohort data. The most frequently evaluated interventions were PrEP (n = 7), PMTCT (n = 4), and HIV testing innovations (n = 3). Oral PrEP was the dominant form, though two studies evaluated long-acting injectable PrEP. Interventions were considered cost-effective if the Incremental Cost Effectiveness Ratio (ICER) was below 1-3 times GDP per capita. For example, dolutegravir-based PMTCT had an ICER of USD109/DALY averted. Peer-delivered self-testing and maternal HIV screening in immunization clinics showed strong economic efficiency. Few studies incorporated real-world data on medication adherence, drop-out or service delivery costs.

Conclusions: Targeted, integrated HIV prevention strategies are cost-effective in SSA. Future studies should improve use of empirical adherence and implementation data and expand focus to underrepresented populations and regions.