Making Structural Uncertainty Transparent in Locally Informed Health Economic Models on HIV Treatment

The transition from efavirenz-based to dolutegravir-based first-line antiretroviral therapy (ART) has reshaped HIV treatment policy globally. Dolutegravir, an integrase strand transfer inhibitor, differs from efavirenz, an older nonnucleoside reverse transcriptase inhibitor, and offers important clinical advantages, particularly for people with HIV strains resistant to efavirenz-based regimens.1 Much of the evidence supporting this transition has come from large international modeling and economic evaluation studies, particularly from sub-Saharan Africa, which have consistently demonstrated the clinical and economic advantages of dolutegravir-based regimens over efavirenz-based therapy.