Department of Decision Sciences, College of Economic and Management Sciences, University of South Africa, Pretoria, South Africa.
Department of Health Policy and Management, School of Public Health, Columbia University, Columbia, Mailman, USA.
J Int AIDS Soc. 2022 Feb;25(2):e25875. doi: 10.1002/jia2.25875.
Adolescent girls and young women (AGYW) are a priority population for pre-exposure prophylaxis (PrEP), a highly effective HIV prevention method. However, effective PrEP use among AGYW has been low. Interventions to support PrEP effective use may improve pill-taking. Affordability of PrEP programs depends on their cost. We, therefore, evaluated the cost of community-based PrEP with effective use counselling.
Cost data from a randomized controlled trial were used to evaluate the cost of PrEP provision with effective use counselling offered to AGYW through community-based HIV testing platforms between November 2018 and November 2019. AGYW were randomized to receive (1) group-based community health club effective use counselling, (2) individualized effective use counselling or (3) community-based PrEP dispensary. Task shifting of effective use counselling from nurses to trained lay counsellors was implemented in groups 1 and 2. Personnel costs were estimated from time-and-motion observations and staff interviews. Expenditure and ingredients-based approaches were used to estimate costs for medical and non-medical supplies.
In total, 603 AGYW initiated PrEP and accrued a total of 1280 months on PrEP. Average cost per person-month on PrEP with group-based community health club, individualized effective use counselling and community-based PrEP dispensary under the Department of Health scenario were similar and high (USD $55.32, $55.65 and $55.46, respectively) due to low PrEP client volume observed in the clinical trial. Increasing client volume (scaled Department of Health scenario) reduced cost per-person month estimates to USD $15.48, $26.40 and $13.99, respectively.
As designed, individualized effective use counselling increased the cost of standard-of-care PrEP delivery by 89%, group-based community health effective use counselling increased the cost of standard-of-care PrEP delivery by 11%. These estimates can inform cost-effectiveness and budget impact analysis for PrEP provision with effective use counselling services.
青少年女孩和年轻女性（AGYW）是暴露前预防（PrEP）的重点人群，PrEP 是一种非常有效的 HIV 预防方法。然而，AGYW 中 PrEP 的有效使用一直很低。支持 PrEP 有效使用的干预措施可能会提高服药依从性。PrEP 项目的可负担性取决于其成本。因此，我们评估了基于社区的 PrEP 与有效使用咨询的成本。
使用随机对照试验的成本数据，评估了 2018 年 11 月至 2019 年 11 月期间通过社区为基础的 HIV 检测平台向 AGYW 提供 PrEP 并提供有效使用咨询的基于社区的 PrEP 的成本。AGYW 被随机分配接受（1）基于群体的社区健康俱乐部有效使用咨询，（2）个体化有效使用咨询或（3）社区为基础的 PrEP 药房。在第 1 组和第 2 组中，将有效使用咨询从护士转移到受过培训的外展顾问。人员成本是根据时间和动作观察和工作人员访谈估算的。采用支出和基于成分的方法估算医疗和非医疗用品的成本。
共有 603 名 AGYW 开始使用 PrEP，累计服用 PrEP 共 1280 个月。在卫生部方案下，基于群体的社区健康俱乐部、个体化有效使用咨询和社区为基础的 PrEP 药房的人均每月 PrEP 成本相似且较高（分别为 55.32 美元、55.65 美元和 55.46 美元），这是因为在临床试验中观察到 PrEP 客户数量较低。增加客户数量（按卫生部方案比例）将人均月费用估计降低至 15.48 美元、26.40 美元和 13.99 美元，分别。
按照设计，个体化有效使用咨询使标准护理 PrEP 交付的成本增加了 89%，基于群体的社区健康有效使用咨询使标准护理 PrEP 交付的成本增加了 11%。这些估计可以为提供有效使用咨询服务的 PrEP 提供提供成本效益和预算影响分析。
