PDF(Pubmed)
Abstract：
Several low- and middle-income countries (LMICs) are preparing to introduce long-acting pre-exposure prophylaxis (LAP). Amid multiple pre-exposure prophylaxis (PrEP) options and constrained funding, decision-makers could benefit from systematic implementation planning and aligned costs. We reviewed national costed implementation plans (CIPs) to describe relevant implementation inputs and activities (domains) for informing the costed rollout of LAP. We assessed how primary costing evidence aligned with those domains.
We conducted a rapid review of CIPs for oral PrEP and family planning (FP) to develop a consensus of implementation domains, and a scoping review across nine electronic databases for publications on PrEP costing in LMICs between January 2010 and June 2022. We extracted cost data and assessed alignment with the implementation domains and the Global Health Costing Consortium principles.
We identified 15 implementation domains from four national PrEP plans and FP-CIP template; only six were in all sources. We included 66 full-text manuscripts, 10 reported LAP, 13 (20%) were primary cost studies-representing seven countries, and none of the 13 included LAP. The 13 primary cost studies included PrEP commodities (n = 12), human resources (n = 11), indirect costs (n = 11), other commodities (n = 10), demand creation (n = 9) and counselling (n = 9). Few studies costed integration into non-HIV services (n = 5), above site costs (n = 3), supply chains and logistics (n = 3) or policy and planning (n = 2), and none included the costs of target setting, health information system adaptations or implementation research. Cost units and outcomes were variable (e.g. average per person-year).
LAP planning will require updating HIV prevention policies, technical assistance for logistical and clinical support, expanding beyond HIV platforms, setting PrEP achievement targets overall and disaggregated by method, extensive supply chain and logistics planning and support, as well as updating health information systems to monitor multiple PrEP methods with different visit schedules. The 15 implementation domains were variable in reviewed studies. PrEP primary cost and budget data are necessary for new product introduction and should match implementation plans with financing.
As PrEP services expand to include LAP, decision-makers need a framework, tools and a process to support countries in planning the systematic rollout and costing for LAP.
We conducted a rapid review of CIPs for oral PrEP and family planning (FP) to develop a consensus of implementation domains, and a scoping review across nine electronic databases for publications on PrEP costing in LMICs between January 2010 and June 2022. We extracted cost data and assessed alignment with the implementation domains and the Global Health Costing Consortium principles.
We identified 15 implementation domains from four national PrEP plans and FP-CIP template; only six were in all sources. We included 66 full-text manuscripts, 10 reported LAP, 13 (20%) were primary cost studies-representing seven countries, and none of the 13 included LAP. The 13 primary cost studies included PrEP commodities (n = 12), human resources (n = 11), indirect costs (n = 11), other commodities (n = 10), demand creation (n = 9) and counselling (n = 9). Few studies costed integration into non-HIV services (n = 5), above site costs (n = 3), supply chains and logistics (n = 3) or policy and planning (n = 2), and none included the costs of target setting, health information system adaptations or implementation research. Cost units and outcomes were variable (e.g. average per person-year).
LAP planning will require updating HIV prevention policies, technical assistance for logistical and clinical support, expanding beyond HIV platforms, setting PrEP achievement targets overall and disaggregated by method, extensive supply chain and logistics planning and support, as well as updating health information systems to monitor multiple PrEP methods with different visit schedules. The 15 implementation domains were variable in reviewed studies. PrEP primary cost and budget data are necessary for new product introduction and should match implementation plans with financing.
As PrEP services expand to include LAP, decision-makers need a framework, tools and a process to support countries in planning the systematic rollout and costing for LAP.
摘要：
背景：一些低收入和中等收入国家（LMICs）正准备引入长效暴露前预防（LAP）。在多种暴露前预防（PrEP）选择和有限的资金中，决策者可以从系统的实施计划和调整成本中受益。我们审查了国家成本实施计划（CIP），以描述相关的实施投入和活动（领域），以告知LAP的成本推出。我们评估了主要成本核算证据与这些领域的一致性。
方法：我们对口头PrEP和计划生育（FP）的CIP进行了快速审查，以形成实施领域的共识，2010年1月至2022年6月期间，对九个电子数据库进行了范围审查，内容涉及LMICs中PrEP成本计算的出版物。我们提取了成本数据，并评估了与实施领域和全球卫生成本核算联盟原则的一致性。
结果：我们从四个国家PrEP计划和FP-CIP模板中确定了15个实施领域；所有来源中只有六个。我们收录了66份全文手稿,10个报告的LAP，13个(20%)是主要成本研究，代表七个国家，13个中没有一个包括LAP。13项主要成本研究包括PrEP商品(n=12)，人力资源(n=11)，间接成本(n=11)，其他商品(n=10)，需求创造(n=9)和咨询(n=9)。很少有研究将成本整合到非艾滋病毒服务中(n=5)，高于现场成本(n=3)，供应链和物流(n=3)或政策和规划(n=2)，没有包括目标设定的成本，卫生信息系统改造或实施研究。成本单位和结果是可变的(例如平均每人每年)。
结论：LAP计划将需要更新艾滋病毒预防政策，后勤和临床支持的技术援助，扩展到艾滋病毒平台之外，按方法总体和分类设置PrEP成就目标，广泛的供应链和物流规划和支持，以及更新健康信息系统以监控具有不同访问时间表的多种PrEP方法。在综述的研究中，15个实施域是可变的。PrEP主要成本和预算数据是新产品推出所必需的，并且应将实施计划与融资相匹配。
结论：随着PrEP服务扩展到包括LAP，决策者需要一个框架，工具和流程，以支持各国规划LAP的系统推出和成本计算。
方法：我们对口头PrEP和计划生育（FP）的CIP进行了快速审查，以形成实施领域的共识，2010年1月至2022年6月期间，对九个电子数据库进行了范围审查，内容涉及LMICs中PrEP成本计算的出版物。我们提取了成本数据，并评估了与实施领域和全球卫生成本核算联盟原则的一致性。
结果：我们从四个国家PrEP计划和FP-CIP模板中确定了15个实施领域；所有来源中只有六个。我们收录了66份全文手稿,10个报告的LAP，13个(20%)是主要成本研究，代表七个国家，13个中没有一个包括LAP。13项主要成本研究包括PrEP商品(n=12)，人力资源(n=11)，间接成本(n=11)，其他商品(n=10)，需求创造(n=9)和咨询(n=9)。很少有研究将成本整合到非艾滋病毒服务中(n=5)，高于现场成本(n=3)，供应链和物流(n=3)或政策和规划(n=2)，没有包括目标设定的成本，卫生信息系统改造或实施研究。成本单位和结果是可变的(例如平均每人每年)。
结论：LAP计划将需要更新艾滋病毒预防政策，后勤和临床支持的技术援助，扩展到艾滋病毒平台之外，按方法总体和分类设置PrEP成就目标，广泛的供应链和物流规划和支持，以及更新健康信息系统以监控具有不同访问时间表的多种PrEP方法。在综述的研究中，15个实施域是可变的。PrEP主要成本和预算数据是新产品推出所必需的，并且应将实施计划与融资相匹配。
结论：随着PrEP服务扩展到包括LAP，决策者需要一个框架，工具和流程，以支持各国规划LAP的系统推出和成本计算。
