Cost of implementing HIV pre-exposure prophylaxis at community-based clinics in Indonesia.

Autor: Siregar AYM; 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., Juwita MN; Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia., Hardiawan D; Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia., Akbar A; 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., Rachman ZH; Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia., Haekal MDF; Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia., Marwah YS; Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia., Putri TA; Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia., Rakhmat FF; Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia., Pohan MN; Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia., Handayani M; Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia., Budiarty TI; Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia., Afriana N; Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia., Prabowo BR; The Joint United Nations Programme on HIV/AIDS (UNAIDS), Jakarta, Indonesia., Wisaksana R; 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.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2024 Jan; Vol. 29 (1), pp. 13-22. Date of Electronic Publication: 2023 Nov 05.
DOI: 10.1111/tmi.13946
Abstrakt: 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.
(© 2023 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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