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Estimating the market size for a dual prevention pill: adding contraception to pre-exposure prophylaxis (PrEP) to increase uptake
  1. Lorna Begg1,
  2. Rebecca Brodsky1,
  3. Barbara Friedland2,
  4. Sanyukta Mathur3,
  5. Jim Sailer1,
  6. George Creasy1
  1. 1Center for Biomedical Research, Population Council, New York, New York, USA
  2. 2HIV and AIDS, Population Council, New York, New York, USA
  3. 3HIV and AIDS, Population Council, Washington, District of Columbia, USA
  1. Correspondence to Lorna Begg, Center for Biomedical Research, Population Council, New York, NY 10065, USA; Lbegg{at}


Introduction Uptake of oral pre-exposure prophylaxis (PrEP) remains low. The objective of this analysis was to estimate the potential market size in priority sub-Saharan African countries for a 28-day dual prevention pill (DPP) regimen containing the active pharmaceutical ingredients in oral PrEP and oral contraceptive pills (OCPs) for the prevention of HIV and unintended pregnancy.

Methods We selected 15 countries in sub-Saharan Africa for analysis. Population estimates were based on United Nations Population Division data from 2017. Low, medium and high rates (range 0.25% to 25%) of estimated conversion from current contraceptive method to the DPP were applied by country based on HIV prevalence (≥10% vs <10%), current contraceptive method (OCP, condom or unmet need for contraception) and age group (15–24 or 25–49 years).

Results In these 15 countries, between 250 000 and 1.25 million women could switch from their current contraceptive method to the DPP. Given that current PrEP use in the 15 countries combined is estimated to be 113 250 (women and men), the most conservative market size estimate would more than double the number of women currently using PrEP.

Conclusions By leveraging the existing market for OCPs and assuming modest conversion from condom users and women with an unmet need for contraception, the DPP could lead to a 2- to 10-fold increase in PrEP usage in these 15 sub-Saharan African countries, expanding the broader public health benefit of this proven HIV prevention strategy.

  • contraceptives, oral
  • HIV
  • reproductive health
  • sexually transmitted diseases
  • contraceptive agents, female

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  • Contributors Analysis designed by RB and LB. Data were analysed by LB. First draft of manuscript prepared by LB, RB, and BF. All authors contributed to revising the manuscript and approved the final version.

  • Funding Preparation of this article was funded by the generous support of the Children’s Investment Fund Foundation.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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