{
  "abstract": "IntroductionMonthly oral HIV pre-exposure prophylaxis (PrEP) such as MK-8527 offer promise as low-cost, self-administered options that are easily delivered through community-based platforms. Economic evaluations of MK-8527 either alone or alongside other long-acting (LA) PrEP products like lenacapavir are needed for informing HIV prevention strategies.\n\nMethodsWe adapted an agent-based network model, EMOD-HIV, to simulate LA-PrEP scale-up in South Africa and western Kenya from 2026-2035; scenarios evaluated MK-8527 alone, lenacapavir alone and combined strategies, with varying uptake among female sex workers, their male clients, and individuals with >1 partner. We assumed 95% effectiveness of MK-8527 for 2 months (assuming individuals took 2 of 3 pills dispensed) and 95% lenacapavir effectiveness for 6 months. Scenarios were compared to a baseline of daily oral PrEP only.\n\nResultsAssuming the same uptake rates, MK-8527 alone achieved lower health impacts than lenacapavir alone in both settings (6-14% vs. 11-18% of HIV infections averted) but had substantially lower costs; provision costs of MK-8527 were 58-59% lower than lenacapavir assuming $1.00/pill and 40-43% lower at $2.50/pill. In western Kenya, ICERs for MK-8527 alone were $467/DALY averted and $799/DALY averted assuming pill prices of $1.00 and $2.50 respectively, compared to $1,306/DALY averted for lenacapavir. In South Africa, all LA-PrEP strategies were cost-saving over the 35-year horizon, although near-term budget impacts were substantial ($169-348 million over five years). Service delivery accounted for the majority of MK-8527 costs (73% at $1.00 per pill). Combined strategies of lenacapavir and MK-8527 increased health benefits (13-23% infections averted) but had higher provision costs than either strategy alone.\n\nConclusionMK-8527 can reduce HIV incidence at lower costs than lenacapavir. However, high service delivery costs limit its cost-effectiveness to scenarios in which pill prices are low (US$1.00 per pill) and provision is targeted to populations at substantial HIV risk.",
  "abstract_shown": true,
  "affiliations": [
    "University of Washington"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "name": "A. Malhotra"
    },
    {
      "name": "N. Patel"
    },
    {
      "name": "D. Kaftan"
    },
    {
      "name": "E. Mudimu"
    },
    {
      "name": "A. Bershteyn"
    },
    {
      "affs": [
        0
      ],
      "name": "M. Sharma"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4dx0jd3xybqpd.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.01.26361983",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26361983v1.full",
  "id": "4dx0jd3xybqpd",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26361983v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health economics"
    ],
    [
      "openalex",
      "2725|HIV/AIDS Research and Interventions"
    ]
  ],
  "openalex": "W7208711509",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26361983v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4dx0jd3xybqpd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:47Z",
      "native_id": "10.64898/2026.09.01.26361983",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26361983v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health economics",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Modeling the health and economic impact of scaling up monthly oral pre-exposure prophylaxis alone or alongside injectable Lenacapavir in Kenya and South Africa",
  "title_text": "Modeling the health and economic impact of scaling up monthly oral pre-exposure prophylaxis alone or alongside injectable Lenacapavir in Kenya and South Africa",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:47Z",
  "url": "https://research.draconitic.com/paper/4dx0jd3xybqpd",
  "venue": "medRxiv",
  "versions": []
}