The Incremental Cost of Delivering PrEP as a Bridge to ART for HIV Serodiscordant Couples in Public HIV Care Clinics in Kenya
The Incremental Cost of Delivering PrEP as a Bridge to ART for HIV Serodiscordant Couples in Public HIV Care Clinics in Kenya
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DOI：
10.1155/2019/4170615
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发表时间：
2019-01-01
影响因子：
1.7
通讯作者：
Heffron, Renee
中科院分区：
文献类型：
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作者：
Irungu, Elizabeth M.;Sharma, Monisha;Heffron, Renee
背景2016年，肯尼亚卫生部（MOH）发布了指导方针，建议对有大量持续艾滋病毒风险的人进行暴露前预防（PrEP），包括那些艾滋病毒血清不一致的伙伴关系。需要估计肯尼亚公共卫生设施内提供PrEP的成本，以规划PrEP的规模。方法.我们估计了为未感染艾滋病毒的伴侣提供PrEP作为一个有时限的桥梁，直到感染的伴侣在艾滋病毒血清不一致的夫妇中接受抗逆转录病毒治疗，作为肯尼亚蒂卡常规诊所护理的一部分，每年的增量成本。从合作伙伴示范项目中收集费用，该项目是对高危艾滋病毒血清不一致夫妇综合提供暴露前预防（PrEP）和抗逆转录病毒治疗（ART）的前瞻性评价。我们进行了时间和运动研究，以区分与研究，常规临床护理和PrEP交付相关的活动。成本（2015年美元）是从卫生部的角度收集的，分为人员、运输、设备、用品、建筑和管理费用以及启动费用。结果在筛选、入组和随访访视期间进行的PrEP相关活动平均分别花费13分钟、51分钟和12分钟。假设工作人员结构为3名顾问，1名护士和2名临床医生，我们估计每年可以筛查3，178对夫妇，1，444对夫妇提供PrEP和ART，6，138对夫妇在平均艾滋病毒护理诊所进行随访。使用卫生部的人员，药物和实验室检测费用，我们估计在现有的ART计划中为未感染艾滋病毒的伴侣提供PrEP的增量成本为每年每对夫妇86.79美元。人员和PrEP药物占成本的最大部分。我们估计，卫生部在公共卫生设施提供综合PrEP和ART计划的总成本为每年每对艾滋病毒血清不一致夫妇250.19美元。结论.在肯尼亚和类似环境中，向艾滋病毒血清不一致夫妇中未感染艾滋病毒的伴侣提供有时限的PrEP可以成为艾滋病毒护理方案中实施的负担得起的交付模式。这些费用可用于预算规划和成本效益分析。
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.