20th International AIDS Conference - Melbourne, Australia


THPE414 - Poster Exhibition

Prospective cost of implementing oral HIV pre-exposure prophylaxis among MSM and young women at risk of HIV in Kenya

M. Kiragu1, H. Kofi1, S. Wanjala1, L. Otiso1, S. Resch2, R. Hecht3, N. Kilonzo1, K. Kripke4

1LVCT Care and Treatment, Nairobi, Kenya, 2Havard School of Public Health, Center for Health Decision Science, Boston, United States, 3Results for Development Institute, Washington DC, United States, 4Futures Institute, Glastonbury, United States

Background: There is a growing body of evidence on the efficacy of oral HIV Pre-exposure prophylaxis (PrEP), and countries with high burden of HIV such as Kenya have considered inclusion of PrEP within their combination prevention efforts. However limited data exists on the cost of implementing PrEP in non-research health service delivery settings. We undertook a study to prospectively estimate the cost of delivering HIV PrEP to men who have sex with men (MSM) and young women at risk of HIV at LVCT, a local indigenous NGO in Nairobi, Kenya.
Methods: A prospective economic costing from the provider perspective was conducted. Financial and programmatic data for the period January to December 2012 were collected from financial and asset records and through interviews. Laboratory, anti-retrovirals (ARV), training, and demand-creation costs were PrEP-specific; proportion of each staff member''s time dedicated to PrEP was estimated by program managers; all other costs were allocated based on the estimated proportion of visits for PrEP clients vs. other clients. Costs were grouped as either direct costs, indirect costs or related costs.
Results: The annual per-client cost of implementing PrEP was estimated at US$618 in the first year after enrolment and US$522 in the second year. An additional US$300 would be incurred if biannual drug level testing was incorporated in the adherence monitoring for PrEP. The major cost drivers included laboratory tests, clinic and laboratory staff time, and antiretroviral drugs. Laboratory tests accounted for 35% (US$217) of total costs in year 1 and 32% (US$168) of total costs in year 2. Clinic and lab staff time accounted for 21.5% (US$133) of total costs in year 1 and 24% (US$127) of total costs in year 2.
Conclusions: These cost estimates may be useful for programs intending to implement oral HIV PrEP in settings similar to LVCT and provide vital inputs for PrEP cost-effectiveness evaluation. Effective task-shifting and adherence monitoring mechanisms that do not require drug level testing would significantly reduce the cost of implementing PrEP and should be explored during upcoming PrEP demonstration studies.

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