Low costs and opportunities for efficiency: a cost analysis of the first year of programmatic PrEP delivery in Kenya’s public sector

作者：Kathryn Peebles, Kenneth K. Mugwanya, Elizabeth Irungu, Josephine Odoyo, Elizabeth Wamoni, Jennifer F. Morton, Kenneth Ngure, Elizabeth A. Bukusi, Nelly Mugo, Sarah Masyuko, Irene Mukui, Jared M. Baeten, Ruanne V. Barnabas, for the Partners Scale-Up Project Team · 发表于：BMC Health Services Research · 年份：2021 · DOI：10.1186/s12913-021-06832-3 · 被引用次数：26 · 研究领域：HIV/AIDS Research and Interventions、Pneumocystis jirovecii pneumonia detection and treatment、HIV, Drug Use, Sexual Risk

BACKGROUND: In 2017, the Kenyan Ministry of Health integrated provision of pre-exposure prophylaxis (PrEP) into public HIV-1 care clinics as a key component of the national HIV-1 prevention strategy. Estimates of the cost of PrEP provision are needed to inform the affordability and cost-effectiveness of PrEP in Kenya. METHODS: We conducted activity-based micro-costing from the payer perspective to estimate both the financial and economic costs of all resources and activities required to provide PrEP in Kenya's public sector. We estimated total and unit costs in 2019 United States dollars from a combination of project expense reports, Ministry of Health training reports, clinic staff interviews, time-and-motion observations, and routinely collected data from PrEP recipient files from 25 high-volume HIV-1 care clinics. RESULTS: In the first year of programmatic PrEP delivery in 25 HIV-1 care clinics, 2,567 persons initiated PrEP and accrued 8,847 total months of PrEP coverage, accounting for 2 % of total outpatient clinic visits. The total financial cost to the Ministry of Health was $91,175, translating to an average of $10.31 per person per month. The majority (69 %) of financial costs were attributable to PrEP medication, followed by administrative supplies (17 %) and training (9 %). Economic costs were higher ($188,584 total; $21.32 per person per month) due to the inclusion of the opportunity cost of staff time re-allocated to provide PrEP and a proportional fraction of fa...