PDF(Pubmed)
Abstract：
UNASSIGNED: Kenya included oral PrEP in the national guidelines as part of combination HIV prevention, and subsequently began providing PrEP to individuals who are at elevated risk of HIV infection in 2017. However, as scale-up continued, there was a recognized gap in knowledge on the cost of delivering oral PrEP. This gap limited the ability of the Government of Kenya to budget for its PrEP scale-up and to evaluate PrEP relative to other HIV prevention strategies. The following study calculated the actual costs of oral PrEP scale-up as it was being delivered in ten counties in Kenya. This costing also allowed for a comparison of various models of service delivery in different geographic regions from the perspective of service providers in Kenya. In addition, the analysis was also conducted to understand factors that indicate why some individuals place a greater value on PrEP than others, using a contingent valuation technique.
UNASSIGNED: Data collection was completed between November 2017 and September 2018. Costing data was collected from 44 Kenyan health facilities, consisting of 23 public facilities, 5 private facilities and 16 drop-in centers (DICEs) through a cross-sectional survey in ten counties. Financial and programmatic data were collected from financial and asset records and through interviewer administered questionnaires. The costs associated with PrEP provision were calculated using an ingredients-based costing approach which involved identification and costing of all the economic inputs (both direct and indirect) used in PrEP service delivery. In addition, a contingent valuation study was conducted at the same 44 facilities to understand factors that reveal why some individuals place a greater value on PrEP than others. Interviews were conducted with 2,258 individuals (1,940 current PrEP clients and 318 non-PrEP clients). A contingent valuation method using a \"payment card approach\" was used to determine the maximum willingness to pay (WTP) of respondents regarding obtaining access to oral PrEP services.
UNASSIGNED: The weighted cost of providing PrEP was $253 per person year, ranging from $217 at health centers to $283 at dispensaries. Drop-in centers (DICEs), which served about two-thirds of the client volume at surveyed facilities, had a unit cost of $276. The unit cost was highest for facilities targeting MSM ($355), while it was lowest for those targeting FSW ($248). The unit cost for facilities targeting AGYW was $323 per person year. The largest percentage of costs were attributable to personnel (58.5%), followed by the cost of drugs, which represented 25% of all costs. The median WTP for PrEP was $2 per month (mean was $4.07 per month). This covers only one-third of the monthly cost of the medication (approximately $6 per month) and less than 10% of the full cost of delivering PrEP ($21 per month). A sizable proportion of current clients (27%) were unwilling to pay anything for PrEP. Certain populations put a higher value on PrEP services, including: FSW and MSM, Muslims, individuals with higher education, persons between the ages of 20 and 35, and households with a higher income and expenditures.
UNASSIGNED: This is the most recent and comprehensive study on the cost of PrEP delivery in Kenya. These results will be used in determining resource requirements and for resource mobilization to facilitate sustainable PrEP scale-up in Kenya and beyond. This contingent valuation study does have important implications for Kenya\'s PrEP program. First, it indicates that some populations are more motivated to adopt oral PrEP, as indicated by their higher WTP for the service. MSM and FSW, for example, placed a higher value on PrEP than AGYW. Higher educated individuals, in turn, put a much higher value on PrEP than those with less education (which may also reflect the higher \"ability to pay\" among those with more education). This suggests that any attempt to increase demand or improve PrEP continuation should consider these differences in client populations. Cost recovery from existing PrEP clients would have potentially negative consequences for uptake and continuation.
UNASSIGNED: Data collection was completed between November 2017 and September 2018. Costing data was collected from 44 Kenyan health facilities, consisting of 23 public facilities, 5 private facilities and 16 drop-in centers (DICEs) through a cross-sectional survey in ten counties. Financial and programmatic data were collected from financial and asset records and through interviewer administered questionnaires. The costs associated with PrEP provision were calculated using an ingredients-based costing approach which involved identification and costing of all the economic inputs (both direct and indirect) used in PrEP service delivery. In addition, a contingent valuation study was conducted at the same 44 facilities to understand factors that reveal why some individuals place a greater value on PrEP than others. Interviews were conducted with 2,258 individuals (1,940 current PrEP clients and 318 non-PrEP clients). A contingent valuation method using a \"payment card approach\" was used to determine the maximum willingness to pay (WTP) of respondents regarding obtaining access to oral PrEP services.
UNASSIGNED: The weighted cost of providing PrEP was $253 per person year, ranging from $217 at health centers to $283 at dispensaries. Drop-in centers (DICEs), which served about two-thirds of the client volume at surveyed facilities, had a unit cost of $276. The unit cost was highest for facilities targeting MSM ($355), while it was lowest for those targeting FSW ($248). The unit cost for facilities targeting AGYW was $323 per person year. The largest percentage of costs were attributable to personnel (58.5%), followed by the cost of drugs, which represented 25% of all costs. The median WTP for PrEP was $2 per month (mean was $4.07 per month). This covers only one-third of the monthly cost of the medication (approximately $6 per month) and less than 10% of the full cost of delivering PrEP ($21 per month). A sizable proportion of current clients (27%) were unwilling to pay anything for PrEP. Certain populations put a higher value on PrEP services, including: FSW and MSM, Muslims, individuals with higher education, persons between the ages of 20 and 35, and households with a higher income and expenditures.
UNASSIGNED: This is the most recent and comprehensive study on the cost of PrEP delivery in Kenya. These results will be used in determining resource requirements and for resource mobilization to facilitate sustainable PrEP scale-up in Kenya and beyond. This contingent valuation study does have important implications for Kenya\'s PrEP program. First, it indicates that some populations are more motivated to adopt oral PrEP, as indicated by their higher WTP for the service. MSM and FSW, for example, placed a higher value on PrEP than AGYW. Higher educated individuals, in turn, put a much higher value on PrEP than those with less education (which may also reflect the higher \"ability to pay\" among those with more education). This suggests that any attempt to increase demand or improve PrEP continuation should consider these differences in client populations. Cost recovery from existing PrEP clients would have potentially negative consequences for uptake and continuation.
摘要：
■肯尼亚将口述PrEP纳入国家指南，作为艾滋病毒综合预防的一部分，随后于2017年开始向HIV感染风险升高的个体提供PrEP.然而,随着规模的扩大，在提供口头PrEP的成本方面存在公认的知识差距.这一差距限制了肯尼亚政府为扩大PrEP预算和评估PrEP相对于其他艾滋病毒预防战略的能力。以下研究计算了在肯尼亚十个县进行口头PrEP扩大的实际成本。这种成本计算还允许从肯尼亚服务提供商的角度比较不同地理区域的各种服务交付模式。此外,还进行了分析，以了解表明为什么有些人比其他人更重视PrEP的因素，使用或有估值技术。
■数据收集在2017年11月至2018年9月之间完成。成本计算数据来自44个肯尼亚卫生机构，由23个公共设施组成，通过对十个县的横断面调查，有5个私人设施和16个住宿中心(DICEs)。财务和方案数据是从财务和资产记录以及通过采访者管理的调查表收集的。与PrEP提供相关的成本是使用基于成分的成本计算方法计算的，该方法涉及对PrEP服务交付中使用的所有经济投入（直接和间接）的识别和成本计算。此外,在相同的44个设施中进行了一项或有评估研究,以了解揭示为什么某些人对PrEP的价值高于其他人的因素.对2,258名个人（1,940名当前PrEP客户和318名非PrEP客户）进行了访谈。使用“支付卡方法”的或有估值方法用于确定受访者获得口头PrEP服务的最大支付意愿（WTP）。
■提供PrEP的加权成本为每人每年253美元，从医疗中心的217美元到药房的283美元不等。投放中心(DICEs),在被调查的设施中，服务了大约三分之二的客户数量，单位成本为276美元。针对MSM的设施的单位成本最高(355美元)，而对于那些瞄准FSW的人来说，这是最低的(248美元)。针对AGYW的设施的单位成本为每人每年323美元。费用占比最大的是人员费用(58.5%),其次是药物的成本，占所有费用的25%。PrEP的WTP中位数为每月2美元（平均为每月4.07美元）。这仅涵盖每月药物费用的三分之一（约每月6美元），不到提供PrEP（每月21美元）的全部费用的10％。相当大比例的现有客户（27％）不愿意为PrEP支付任何费用。某些人群对PrEP服务的价值更高，包括：FSW和MSM，穆斯林,受过高等教育的人，年龄在20至35岁之间的人，以及收入和支出较高的家庭。
■这是对肯尼亚PrEP交付成本的最新和全面研究。这些结果将用于确定资源需求和资源调动，以促进肯尼亚及其他地区可持续的PrEP扩大规模。这项或有价值的评估研究确实对肯尼亚的PrEP计划具有重要意义。首先,这表明一些人群更有动力采用口头PrEP，正如他们对服务的更高WTP所表明的那样。MSM和FSW,例如,在PrEP上放置比AGYW更高的值。受过高等教育的人，反过来,与受教育程度较低的人相比，对PrEP的重视要高得多（这也可能反映了受教育程度较高的人的“支付能力”）。这表明，任何增加需求或改善PrEP延续的尝试都应考虑客户群体的这些差异。从现有的PrEP客户中收回成本可能会对吸收和延续产生负面影响。
■数据收集在2017年11月至2018年9月之间完成。成本计算数据来自44个肯尼亚卫生机构，由23个公共设施组成，通过对十个县的横断面调查，有5个私人设施和16个住宿中心(DICEs)。财务和方案数据是从财务和资产记录以及通过采访者管理的调查表收集的。与PrEP提供相关的成本是使用基于成分的成本计算方法计算的，该方法涉及对PrEP服务交付中使用的所有经济投入（直接和间接）的识别和成本计算。此外,在相同的44个设施中进行了一项或有评估研究,以了解揭示为什么某些人对PrEP的价值高于其他人的因素.对2,258名个人（1,940名当前PrEP客户和318名非PrEP客户）进行了访谈。使用“支付卡方法”的或有估值方法用于确定受访者获得口头PrEP服务的最大支付意愿（WTP）。
■提供PrEP的加权成本为每人每年253美元，从医疗中心的217美元到药房的283美元不等。投放中心(DICEs),在被调查的设施中，服务了大约三分之二的客户数量，单位成本为276美元。针对MSM的设施的单位成本最高(355美元)，而对于那些瞄准FSW的人来说，这是最低的(248美元)。针对AGYW的设施的单位成本为每人每年323美元。费用占比最大的是人员费用(58.5%),其次是药物的成本，占所有费用的25%。PrEP的WTP中位数为每月2美元（平均为每月4.07美元）。这仅涵盖每月药物费用的三分之一（约每月6美元），不到提供PrEP（每月21美元）的全部费用的10％。相当大比例的现有客户（27％）不愿意为PrEP支付任何费用。某些人群对PrEP服务的价值更高，包括：FSW和MSM，穆斯林,受过高等教育的人，年龄在20至35岁之间的人，以及收入和支出较高的家庭。
■这是对肯尼亚PrEP交付成本的最新和全面研究。这些结果将用于确定资源需求和资源调动，以促进肯尼亚及其他地区可持续的PrEP扩大规模。这项或有价值的评估研究确实对肯尼亚的PrEP计划具有重要意义。首先,这表明一些人群更有动力采用口头PrEP，正如他们对服务的更高WTP所表明的那样。MSM和FSW,例如,在PrEP上放置比AGYW更高的值。受过高等教育的人，反过来,与受教育程度较低的人相比，对PrEP的重视要高得多（这也可能反映了受教育程度较高的人的“支付能力”）。这表明，任何增加需求或改善PrEP延续的尝试都应考虑客户群体的这些差异。从现有的PrEP客户中收回成本可能会对吸收和延续产生负面影响。
