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Siregar AYM, Juwita MN, Hardiawan D, Akbar A, Rachman ZH, Haekal MDF, Marwah YS, Putri TA, Rakhmat FF, Pohan MN, Handayani M, Budiarty TI, Afriana N, Prabowo BR, Wisaksana R. Cost of implementing HIV pre-exposure prophylaxis at community-based clinics in Indonesia. Trop Med Int Health 2024; 29:13-22. [PMID: 37926554 DOI: 10.1111/tmi.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Currently, Indonesia still has one of the highest rates of new HIV/AIDS infections among countries in Asia and the Pacific region. The WHO has recommended pre-exposure prophylaxis (PrEP) as an additional HIV epidemic prevention step, which has been applied globally and related to the reduction in the number of HIV cases. However, information on the cost of implementing PrEP is rarely available in developing countries, especially in Southeast Asia. Designing a cost-effective approach to scale up PrEP and to estimate the potential budget impact requires information on the cost of implementing PrEP. This study aims to estimate the cost of implementing PrEP at community-based clinics in Indonesia. METHODS We collected healthcare and non-healthcare/client costs from nine community-based clinics in various cities/districts in Indonesia. The healthcare costs included data on resource utilisation and costs to deliver PrEP, divided into recurrent and capital costs using a discount rate of 3%. Non-healthcare costs included out-of-pocket costs (e.g., transportation, meals) and productivity loss by clients and accompanying person(s) in accessing PrEP. On average, we interviewed 27 clients/clinic. RESULTS The annual cost of providing PrEP per client is US $365.03, 39% lower than the yearly cost of antiretroviral treatment (ART) per person (approximately US $600). Drugs and non-healthcare costs contribute approximately 67% of the cost. The cost of PrEP amounts to US $292,756.45/year, covering 802 clients. The non-healthcare cost per visit at all sites never reaches more than 10% of the average monthly household expenditure. CONCLUSIONS The cost of providing PrEP per person is approximately US $365 and is 39% lower than the annual cost of ART per person. Lowering the cost of PrEP ARV drugs would reduce the cost. Scaling up PrEP should recognise this cost structure and strive to reach economies of scale as the intervention gains more clients while simultaneously controlling new HIV infections.
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Affiliation(s)
- Adiatma Yudistira Manogar Siregar
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
- West Java Development Institute (INJABAR), Universitas Padjadjaran, Bandung, Indonesia
- Center for Health Technology Assessment (CHTA), Universitas Padjadjaran, Bandung, Indonesia
| | - Mery Nurma Juwita
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Donny Hardiawan
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Adhadian Akbar
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
- West Java Development Institute (INJABAR), Universitas Padjadjaran, Bandung, Indonesia
| | - Zulfa Haitan Rachman
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Muhammad Dzaki Fahd Haekal
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Yuvi Siti Marwah
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Tarinanda Adzani Putri
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Fani Fadillah Rakhmat
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Mawar Nita Pohan
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Miasari Handayani
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | | | | | | | - Rudi Wisaksana
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Departement of Internal Medicine Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin Hospital, Bandung, Indonesia
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Kohler S, Dalal S, Hettema A, Matse S, Bärnighausen T, Paul N. Out-of-pocket Expenses and Time Spent on Clinic Visits Among HIV Pre-exposure Prophylaxis Users and Other Clinic Attendees in Eswatini. AIDS Behav 2023; 27:1222-1233. [PMID: 36219271 PMCID: PMC9551250 DOI: 10.1007/s10461-022-03859-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
User costs constitute a barrier to the uptake of HIV pre-exposure prophylaxis (PrEP), but their magnitude appears rarely assessed. In this prospective observational study, we assessed self-reported out-of-pocket expenses (OOPE) and time spent on clinic visits during a PrEP demonstration project in Eswatini. At six public primary care clinics, 240 PrEP users and other clinic attendees were interviewed after a clinic visit. Among the 79.2% of clinic attendees reporting any medical OOPE (e.g., expenses for consultations or drugs) and/or non-medical OOPE (e.g., expenses for transport, food, or phone use), the median total OOPE was $1.36 (IQR 0.91-1.96). Non-medical OOPE occurred mostly due to transport expenses. The median travel time for a clinic visit was 1.0 h (IQR 0.67-2.0). The median time spent in the clinic was 2.0 h (IQR 1.15-3.0). The median opportunity cost of a clinic visit was $7.54 (IQR 5.42-11) when valuing time spent on a clinic visit with Eswatini's per-capita gross domestic product. Our findings can guide measures to reduce the user costs of PrEP in Eswatini and other contexts in which oral PrEP is provided through health care facilities.
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Affiliation(s)
- Stefan Kohler
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
| | - Shona Dalal
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | | | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nicolas Paul
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
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Choi SK, Golinkoff J, Lin WY, Hightow-Weidman L, Muessig K, Bauermeister J. Current and Future Perspectives of HIV Prevention Research Among Young Sexual Minority Men in South Korea. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:721-732. [PMID: 36097068 PMCID: PMC9466347 DOI: 10.1007/s10508-022-02403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Social stigma within Korean society hinders structural efforts to reduce HIV disparities among sexual minority men (SMM). To date, however, there have been limited intervention efforts to reduce HIV disparities among SMM in Korea. Therefore, the current mixed-methods study (n = 180) explored young Korean SMM's perspectives on the acceptability of HIV prevention mHealth interventions to inform effective strategies for future intervention studies. We then analyzed participants' comments and suggestions on HIV research and examined associations with the acceptability of mHealth interventions. Through our textual coding and analysis, we identified four primary themes for comments and suggestions for HIV research in Korea: the centrality of stigma, health service accessibility, informational accessibility, and cultural adaptation. Our study suggests culturally adapted HIV intervention addressing stigma, health service accessibility, and information accessibility and mHealth interventions disseminating information and resources for stigmatized young SMM in Korea.
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Affiliation(s)
- Seul Ki Choi
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA.
| | - Jesse Golinkoff
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA
| | - Willey Y Lin
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA
| | - Lisa Hightow-Weidman
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Muessig
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - José Bauermeister
- Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd., Room 243L, Philadelphia, PA, 19104, USA
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Li J, Gilmour S, Wang Y, Gu J, Lau JTF. Time to consider elimination of HIV in China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 24:100497. [PMID: 35677147 PMCID: PMC9168685 DOI: 10.1016/j.lanwpc.2022.100497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yijing Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Joseph Tak-fai Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Quirola-Amores P, Espinosa P, Oleas S, Hernandez I, Henriquez AR, Teran E. HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis. Front Public Health 2022; 10:884313. [PMID: 35784197 PMCID: PMC9247332 DOI: 10.3389/fpubh.2022.884313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/23/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction HIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy “95–95–95” which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost–utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts. Methods For the cost–utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths. Results Cost–benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (–$591, –$4,360) and −108 and −934 DALYs, in the case of ART and PrEP, ICER the $30,541–$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10–12 years of healthy life. Conclusion CUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life.
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Affiliation(s)
- Paulina Quirola-Amores
- Instituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Pablo Espinosa
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
- Facultad de Medicina, Medicina, Universidad de Las Américas, Quito, Ecuador
| | - Sebastian Oleas
- Instituto de Economía, Universidad San Francisco de Quito, Quito, Ecuador
| | - Isabel Hernandez
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | | | - Enrique Teran
- Instituto de Microbiología, Universidad San Francisco de Quito, Quito, Ecuador
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
- *Correspondence: Enrique Teran
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