The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia.
The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia.
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DOI：
10.1371/journal.pgph.0001246
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Nichols, Brooke E
中科院分区：
文献类型：
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作者：
Hendrickson, Cheryl;Long, Lawrence C;van Rensburg, Craig;Claassen, Cassidy W;Njelesani, Mwansa;Moyo, Crispin;Mulenga, Lloyd;O'Bra, Heidi;Russell, Colin A;Nichols, Brooke E
暴露前预防(PrEP)是一种有效的艾滋病毒预防选择，但成本效益对实施和计划成本敏感。研究表明，除了直接交付成本外，PrEP的提供还需要大量的需求创造和客户支持，以鼓励PrEP的启动和持续。我们估计了在赞比亚通过不同的PrEP交付模式提供PrEP的成本。采用基于指导方针的访问、实验室和药物方法，我们估计了为五种交付模式为每个客户提供PrEP的年成本：一种侧重于关键人群(男男性行为者(MSM)和女性性工作者(FSW)，一种针对青春期女孩和年轻女性(AGYW)，以及三个综合项目(在初级保健中心的艾滋病毒咨询和检测服务中运营)。项目启动和支持成本基于2018年的项目支出数据以及PrEP站点和客户数量。预备诊所就诊成本是基于两个PrEP交付地点的微观成本计算的(2018美元)。成本以2018年价格列示，并被夸大到2021年价格。年度费用/PrEP客户因提供服务的模式不同而不同，从394美元(AGYW)到655美元(综合模式)。成本差异在很大程度上是由客户数量推动的，这影响了分配给每个PrEP客户的方案支持和技术援助的相对成本。直接服务交付成本仅为205-212美元/PrEP-客户，是PrEP成本的关键组成部分，占总成本的35%-65%。结果表明，即使在纳入全面服务提供模式时，由于社区宣传和客户支持所涉及的方案成本，接触有很大艾滋病毒感染风险的弱势、边缘化人口的费用可能比以前估计的要高。为了更好地了解赞比亚不同PrEP服务交付计划的真实资源利用率、预期结果和年度成本，需要改进有关个别客户资源使用情况和结果的数据。
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to $655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35–65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia.