Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
J Int AIDS Soc. 2023 Jul;26 Suppl 2(Suppl 2):e26110. doi: 10.1002/jia2.26110.
Several low- and middle-income countries (LMICs) are preparing to introduce long-acting pre-exposure prophylaxis (LAP). Amid multiple pre-exposure prophylaxis (PrEP) options and constrained funding, decision-makers could benefit from systematic implementation planning and aligned costs. We reviewed national costed implementation plans (CIPs) to describe relevant implementation inputs and activities (domains) for informing the costed rollout of LAP. We assessed how primary costing evidence aligned with those domains.
We conducted a rapid review of CIPs for oral PrEP and family planning (FP) to develop a consensus of implementation domains, and a scoping review across nine electronic databases for publications on PrEP costing in LMICs between January 2010 and June 2022. We extracted cost data and assessed alignment with the implementation domains and the Global Health Costing Consortium principles.
We identified 15 implementation domains from four national PrEP plans and FP-CIP template; only six were in all sources. We included 66 full-text manuscripts, 10 reported LAP, 13 (20%) were primary cost studies-representing seven countries, and none of the 13 included LAP. The 13 primary cost studies included PrEP commodities (n = 12), human resources (n = 11), indirect costs (n = 11), other commodities (n = 10), demand creation (n = 9) and counselling (n = 9). Few studies costed integration into non-HIV services (n = 5), above site costs (n = 3), supply chains and logistics (n = 3) or policy and planning (n = 2), and none included the costs of target setting, health information system adaptations or implementation research. Cost units and outcomes were variable (e.g. average per person-year).
LAP planning will require updating HIV prevention policies, technical assistance for logistical and clinical support, expanding beyond HIV platforms, setting PrEP achievement targets overall and disaggregated by method, extensive supply chain and logistics planning and support, as well as updating health information systems to monitor multiple PrEP methods with different visit schedules. The 15 implementation domains were variable in reviewed studies. PrEP primary cost and budget data are necessary for new product introduction and should match implementation plans with financing.
As PrEP services expand to include LAP, decision-makers need a framework, tools and a process to support countries in planning the systematic rollout and costing for LAP.
一些中低收入国家（LMICs）正准备引入长效暴露前预防（LAP）。在多种暴露前预防（PrEP）选择和有限资金的情况下，决策者可以从系统的实施规划和协调成本中受益。我们审查了国家成本实施计划（CIP），以描述与 LAP 推出相关的实施投入和活动（领域）。我们评估了主要成本核算证据与这些领域的一致性。
我们对口服 PrEP 和计划生育（FP）的 CIP 进行了快速审查，以制定实施领域的共识，并在九个电子数据库中进行了范围审查，以获取 2010 年 1 月至 2022 年 6 月期间中低收入国家 PrEP 成本核算的出版物。我们提取了成本数据，并评估了与实施领域和全球卫生成本核算联盟原则的一致性。
我们从四个国家 PrEP 计划和 FP-CIP 模板中确定了 15 个实施领域；只有六个领域在所有来源中都有涉及。我们纳入了 66 篇全文手稿，其中 10 篇报告了 LAP，13 篇（20%）是 PrEP 成本研究，代表了七个国家，但没有一篇包含 LAP。这 13 项主要成本研究包括 PrEP 商品（n = 12）、人力资源（n = 11）、间接成本（n = 11）、其他商品（n = 10）、需求创造（n = 9）和咨询（n = 9）。很少有研究涉及整合到非 HIV 服务（n = 5）、站点以上成本（n = 3）、供应链和物流（n = 3）或政策和规划（n = 2），也没有研究涉及目标设定、卫生信息系统调整或实施研究的成本。成本单位和结果各不相同（例如，人均年）。
LAP 规划将需要更新艾滋病毒预防政策、后勤和临床支持方面的技术援助、扩大 HIV 平台、总体和按方法细分设定 PrEP 目标、广泛的供应链和物流规划和支持，以及更新卫生信息系统以监测不同方法的多种 PrEP 方法，这些方法的就诊时间表不同。在审查的研究中，15 个实施领域各不相同。新的 PrEP 产品引入需要 PrEP 初级成本和预算数据，并应使实施计划与融资相匹配。
随着 PrEP 服务的扩大，包括 LAP，决策者需要一个框架、工具和流程，以支持各国规划 LAP 的系统推出和成本核算。
