ArticleNature communications2026
Cost-effectiveness of a smart pillbox intervention for adherence to oral HIV pre-exposure prophylaxis.
Article in Nature communications, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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0 citing papers in PubMed.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite proven oral pre-exposure prophylaxis (PrEP) efficacy, adherence barriers among men who have sex with men (MSM) persist. Economic viability of digital adherence tools in low- and middle-income countries (LMICs) requires validation. We assessed the 6-month within-trial cost-effectiveness of a digital intervention for real-time enhancement of oral PrEP adherence (DIRECT-PrEP) in China, from health system, multipayer, and societal perspectives. Costs were derived from hospital records, and effectiveness was evaluated using quality-adjusted life-years (QALYs) and PrEP-adherence days (PADs). Among 442 participants (247 intervention, 195 standard care), incremental costs per QALY gained for the smart pillbox intervention were $19,575.93 (health system), $19,656.66 (multipayer), and $19,844.42 (societal)-all below the cost-effectiveness threshold of three times per capita gross domestic product ($31,200). Costs per PAD gained were $30.46-$30.86, achieving >95% probability of cost-effectiveness at willingness-to-pay thresholds of $47.50-$48.50 per PAD. Notably, the intervention demonstrated greater cost-effectiveness per QALY among participants stratified as more socially vulnerable ($16,259.77-$16,490.41) compared with those classified as less socially vulnerable ($23,514.83-$23,834.38). These results establish the smart-pillbox digital intervention as a cost-effective strategy for oral PrEP adherence within primary healthcare settings in LMICs, particularly when prioritizing more socially vulnerable populations, though long-term scalability requires further validation.
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