Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
J Int AIDS Soc. 2019 Jul;22 Suppl 4(Suppl Suppl 4):e25296. doi: 10.1002/jia2.25296.
Understanding the cost of strategies to reach and deliver pre-exposure prophylaxis (PrEP) to priority populations is essential to assess the cost-effectiveness and budget impact of HIV prevention programmes. Providing PrEP through maternal and child health and family planning clinics offers a promising strategy to reach women in high HIV burden settings. We estimated incremental costs and explored the cost drivers of integrating PrEP delivery into routine maternal and child health and family planning services in Kenya.
We conducted a costing study from the provider perspective within the PrEP Implementation for Young Women and Adolescents programme in western Kenya. We identified all within- and above-facility activities supporting PrEP delivery and measured clinical service time using time-and-motion studies. We obtained input costs from programme budgets, expenditure records and staff interviews. We estimated changes in costs if creatinine testing were postponed from initiation to first follow-up visit and if PrEP were prioritized to clients at high HIV risk using a behavioural risk assessment tool. We also projected costs under Ministry of Health (MOH) implementation assuming MOH salaries and programme supervision. We estimated annual numbers of PrEP visits from programme data abstracted from 16 facilities between November 2017 and June 2018. We report the cost per client-month of PrEP dispensed in 2017 USD.
For an annual programme output of 24,005 screenings, 4198 PrEP initiations and 4427 follow-up visits, the average cost per client-month of PrEP dispensed in the study was $26.52. Personnel, drugs and laboratory tests comprised 43%, 25% and 14% of programme costs respectively. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk reduced total programme costs by 8% and 14% respectively. In the MOH scenario assuming no changes in outputs, the projected cost per client-month of PrEP dispensed decreased to $16.54 and total programme costs decreased by 38%.
Incremental PrEP costs are sensitive to the service delivery strategy used to engage priority populations. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk may reduce costs. Context-specific cost data are crucial to assess the cost-effectiveness and affordability of PrEP delivery models.
了解为重点人群提供和实施暴露前预防（PrEP）的策略的成本，对于评估艾滋病毒预防规划的成本效益和预算影响至关重要。通过母婴健康和计划生育诊所提供 PrEP 是在高艾滋病毒负担环境中为妇女提供服务的一种有前途的策略。我们估计了肯尼亚将 PrEP 交付纳入常规母婴健康和计划生育服务的增量成本，并探讨了成本驱动因素。
我们在肯尼亚西部的年轻妇女和青少年 PrEP 实施计划中，从提供者的角度进行了成本研究。我们确定了所有支持 PrEP 交付的院内和院外活动，并使用时间和动作研究测量临床服务时间。我们从方案预算、支出记录和员工访谈中获取投入成本。如果肌酐检测从启动推迟到第一次随访，或者如果 PrEP 优先考虑使用行为风险评估工具的高艾滋病毒风险客户，我们估计了成本的变化。我们还根据卫生部（MOH）的实施假设，即卫生部的工资和方案监督，预测了成本。我们根据 2017 年 11 月至 2018 年 6 月从 16 个设施提取的方案数据，估计了每年 PrEP 就诊次数。我们报告了 2017 年每客户/月的 PrEP 处方成本，以美元计。
对于每年 24005 次筛查、4198 次 PrEP 启动和 4427 次随访的方案产出，研究中每客户/月的 PrEP 处方平均成本为 26.52 美元。人员、药品和实验室检测分别占方案成本的 43%、25%和 14%。推迟肌酐检测和优先考虑高艾滋病毒风险客户的 PrEP 交付分别使总方案成本降低了 8%和 14%。在卫生部方案输出不变的假设下，预计每客户/月的 PrEP 处方成本降至 16.54 美元，总方案成本下降 38%。
增量 PrEP 成本对用于接触重点人群的服务提供策略敏感。推迟肌酐检测和优先考虑高艾滋病毒风险客户的 PrEP 交付可能会降低成本。具体情况的成本数据对于评估 PrEP 交付模式的成本效益和负担能力至关重要。
