The Incremental Cost of Delivering PrEP as a Bridge to ART for HIV Serodiscordant Couples in Public HIV Care Clinics in Kenya
Year: 2019
Type: article
Abstract: BACKGROUND: In 2016, the Kenyan Ministry of Health (MOH) released guidelines that recommend preexposure prophylaxis (PrEP) for persons with substantial ongoing HIV risk, including those in HIV serodiscordant partnerships. Estimates of the costs of delivering PrEP within Kenyan public health facilities are needed for planning for PrEP scale up. METHODS: We estimated the incremental annual costs of providing PrEP to HIV uninfected partners as a time-limited "bridge" until the infected partner is virally suppressed on ART within HIV serodiscordant couples as part of routine clinic care in Thika, Kenya. Costs were collected from the Partners Demonstration Project, a prospective evaluation of integrated delivery of preexposure prophylaxis (PrEP) and antiretroviral therapy (ART) to high-risk HIV serodiscordant couples. We conducted time and motion studies to distinguish between activities related to research, routine clinical care, and PrEP delivery. Costs (2015 US dollars) were collected from the MOH perspective and divided into staff, transportation, equipment, supplies, buildings and overhead, and start-up. RESULTS: PrEP related activities conducted during the screening, enrollment, and follow-up visits took an average of 13 minutes, 51 minutes, and 12 minutes, respectively. Assuming a staff structure of 3 counselors, 1 nurse, and 2 clinicians, we estimate that 3,178 couples can be screened, 1,444 couples offered PrEP and ART, and 6,138 couples followed up annually in an average HIV care clinic. Using costs incurred by the MOH for personnel, drug, and laboratory tests, we estimate that the incremental cost of offering PrEP to HIV uninfected partners within existing ART programs is $86.79 per couple per year. Personnel and PrEP medication made up the largest portion of the costs. We estimate that the total cost to Ministry of Health of delivering integrated PrEP and ART program in public health facilities is $250.19 per HIV serodiscordant couple per year. CONCLUSIONS: Time-limited provision of PrEP to the HIV uninfected partner within HIV serodiscordant couples can be an affordable delivery model implemented in HIV care programs in Kenya and similar settings. These costs can be used for budgetary planning and cost effectiveness analyses.
Source: AIDS Research and Treatment
DOI: 10.1155/2019/4170615
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,000
Funders: United States Agency for International Development, Bill and Melinda Gates Foundation, University of Washington, National Institutes of Health, Center for AIDS Research, University of Washington, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, NIH Office of the Director, National Cancer Institute, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, Office of Research on Women's Health
Awards: Delivery of integrated PrEP and ART for HIV prevention for couples in Kenya, G1239442140, G1323885547, G1408166709, G2219438539, G2319251904, G2324400147, G2517870720, G2537932731, G2645398418, G2732545372, Optimizing Delivery of ART/PrEP for HIV Prevention through Qualitative Research, G3146707573, G3219969598, Northern/Pacific Universities Global Health Research Training Consortium, G3407947818, G3663721632, G3719028072, G3781825217, G3820666216, G3985073149, G4327497402, G4393346530, G4847806209, G5188386409, G5407617110, G5677752096, G5853358977, G6106727576, APP - AAD 936-3090, G6474256992, G6546035474, G674739466, G6802846633, G7033575271, G726642961, G7475023035, G7551235651, G7579028220, G7791962275, G7889379128, G7934442257, G7965387109, G8705280296, G8863239898, G895661274, G9000020862, G9000186388, G9000217563, University of Washington/Fred Hutch Center for AIDS Research
OpenAlex ID: W2943784055