HIV pre-exposure prophylaxis in US prison settings: a model-based cost-effectiveness study

Summary: Background: HIV prevalence in prisons is three times higher than in the general community, and ongoing transmission risks highlight the importance of prevention, including pre-exposure prophylaxis (PrEP). We evaluated the effectiveness and cost-effectiveness of prison-based PrEP programs in four US states.

Methods

We developed a dynamic compartmental model simulating HIV transmission in both general and incarcerated populations, instantiated for four representative US states (standardized population of five million people). We assessed five strategies involving PrEP for specific risk groups in prison compared to the status quo of no PrEP. We assumed 25% uptake among eligible individuals for 20 years. We estimated total lifetime costs (in 2024 USD) and quality-adjusted life-years (QALYs), discounted at 3% annually, incremental cost-effectiveness ratios (ICERs), and HIV infections averted from a healthcare sector perspective.