Department of Epidemiology, Columbia University Mailman School of Public Health, 622 West 168th Street, 8th Floor, New York, NY, 10032, United States of America.
Division of Infectious Diseases, Columbia University Irving Medical Center, 622 West 168th Street, 8th Floor, New York, NY, 10032, United States of America.
Health Res Policy Syst. 2024 Nov 25;22(1):156. doi: 10.1186/s12961-024-01240-5.
Costing and financing systematic implementation are recognized barriers to human immunodeficiency virus (HIV) prevention. In the absence of empiric implementation and economic data, perspectives from international stakeholders involved in developing and supporting daily oral pre-exposure prophylaxis (PrEP) policy, and programs can provide critical insights for developing costed plans to support and accelerate the rollout of novel long-acting PrEP (LA-PrEP) methods, such as the monthly dapivirine vaginal ring (PrEP ring).
We interviewed stakeholders from purposively selected international organizations about anticipated PrEP-ring implementation costs, evidence gaps and key process steps for developing a costed rollout plan template (CRPT). We deductively analysed interviews.
The 27 stakeholders (11 donors, 10 nongovernmental, 4 academic/research, 2 multilateral) identified 10 cost-related themes: 7 for planning and implementation and 3 for financing, costing and budgeting. Planning and implementation cost considerations included: (1) actionable target setting; (2) multilevel communication strategies for awareness-raising, demand creation, client-level adherence and choice counselling; (3) human resources, encompassing task shifting and integration into non-HIV services; (4) supply chain costs, including commodities, manufacturing diversification, packaging and forecasting; (5) laboratory infrastructure and monitoring; (6) updated health information systems and metrics to monitor and evaluate multiple methods integrated into HIV, non-HIV and de-medicalized delivery settings; and (7) technical assistance and knowledge management. Themes for financing, costing and budgeting comprised: (8) cost and budget analyses, such as cost-effectiveness; (9) economic evidence gaps on service integration; and (10) innovative or co-financing for sustainable and equitable allocation of limited financial resources to support accelerated PrEP-ring delivery. We organized these themes within the CRPT.
The CRPT could expedite planning and enhance the pace and scale of optimized, systematic and sustainable delivery of PrEP methods. Further research is needed to evaluate use cases of the CRPT.
成本核算和融资是阻碍实施人类免疫缺陷病毒（HIV）预防的系统实施的公认障碍。在缺乏经验性实施和经济数据的情况下，参与制定和支持每日口服暴露前预防（PrEP）政策和方案的国际利益相关者的观点可以为制定支持和加速新型长效 PrEP（LA-PrEP）方法（如每月多替拉韦阴道环（PrEP 环））的成本核算计划提供重要见解。
我们采访了来自有针对性选择的国际组织的利益相关者，了解他们对预期 PrEP 环实施成本、证据差距以及制定成本核算推出计划模板（CRPT）的关键流程步骤的看法。我们对访谈进行了演绎分析。
27 名利益相关者（11 名捐助者、10 名非政府组织、4 名学术/研究人员、2 名多边组织）确定了 10 个与成本相关的主题：7 个用于规划和实施，3 个用于融资、成本核算和预算编制。规划和实施成本考虑因素包括：（1）可操作的目标设定；（2）多层次的沟通策略，用于提高认识、创造需求、客户层面的坚持和选择咨询；（3）人力资源，包括任务转移和整合到非 HIV 服务中；（4）供应链成本，包括商品、制造多样化、包装和预测；（5）实验室基础设施和监测；（6）更新的卫生信息系统和指标，以监测和评估整合到 HIV、非 HIV 和去医疗化交付环境中的多种方法；（7）技术援助和知识管理。融资、成本核算和预算编制主题包括：（8）成本和预算分析，如成本效益；（9）服务整合的经济证据差距；（10）创新或共同融资，以支持加速 PrEP 环推出的有限财务资源的可持续和公平分配。我们将这些主题组织在 CRPT 中。
CRPT 可以加快规划并提高优化、系统和可持续提供 PrEP 方法的速度和规模。需要进一步研究来评估 CRPT 的用例。
