Assessing the potential epidemiological impact and cost-effectiveness of a status-neutral HIV care approach integrated with other sexual health services for adolescents and young adults in South Africa: a mathematical modelling study

In South Africa, despite freely available and effective HIV treatment and prevention, 210,000 new infections and 51,000 deaths occurred in 2021. Sexually active adolescents and young adults (AYA) face disproportionately high rates of HIV acquisition and gaps in HIV-diagnosis and treatment. A “status-neutral” approach, which links clients to appropriate services regardless of whether they test positive or negative (i.e., to either care or prevention) and co-delivers other important sexual and reproductive health (SRH) services, is now the standard-of-care for AYA in New York City and is being tested in two clinical trials in South Africa. I hypothesize that in South Africa, a status-neutral approach can greatly and cost-effectively reduce HIV-incidence and burden in AYA by preventing HIV infections, strengthening diagnosis and treatment, and addressing unmet SRH needs that exacerbate HIV risk. Leveraging the unique opportunity of data accruing from South African clinical trials, I propose to use a previously validated HIV epidemiological model to estimate the long-term population level impact and cost-effectiveness of this status-neutral approach and its individual components in different settings. Modelling will also help to explore the mechanisms and discover the active ingredients that underlie clinical trial findings and inform health policy, scalability, and future studies.