{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T06:50:52Z","timestamp":1781938252835,"version":"3.54.5"},"reference-count":45,"publisher":"Wiley","issue":"S4","license":[{"start":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T00:00:00Z","timestamp":1563753600000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Understanding the cost of strategies to reach and deliver pre\u2010exposure prophylaxis (PrEP) to priority populations is essential to assess the cost\u2010effectiveness and budget impact of HIV prevention programmes. Providing PrEP through maternal and child health and family planning clinics offers a promising strategy to reach women in high HIV burden settings. We estimated incremental costs and explored the cost drivers of integrating PrEP delivery into routine maternal and child health and family planning services in Kenya.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a costing study from the provider perspective within the PrEP Implementation for Young Women and Adolescents programme in western Kenya. We identified all within\u2010 and above\u2010facility activities supporting PrEP delivery and measured clinical service time using time\u2010and\u2010motion studies. We obtained input costs from programme budgets, expenditure records and staff interviews. We estimated changes in costs if creatinine testing were postponed from initiation to first follow\u2010up visit and if PrEP were prioritized to clients at high HIV risk using a behavioural risk assessment tool. We also projected costs under Ministry of Health (MOH) implementation assuming MOH salaries and programme supervision. We estimated annual numbers of PrEP visits from programme data abstracted from 16 facilities between November 2017 and June 2018. We report the cost per client\u2010month of PrEP dispensed in 2017 USD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For an annual programme output of 24,005 screenings, 4198 PrEP initiations and 4427 follow\u2010up visits, the average cost per client\u2010month of PrEP dispensed in the study was $26.52. Personnel, drugs and laboratory tests comprised 43%, 25% and 14% of programme costs respectively. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk reduced total programme costs by 8% and 14% respectively. In the MOH scenario assuming no changes in outputs, the projected cost per client\u2010month of PrEP dispensed decreased to $16.54 and total programme costs decreased by 38%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Incremental PrEP costs are sensitive to the service delivery strategy used to engage priority populations. Postponing creatinine testing and prioritizing PrEP delivery to clients at high HIV risk may reduce costs. Context\u2010specific cost data are crucial to assess the cost\u2010effectiveness and affordability of PrEP delivery models.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25296","type":"journal-article","created":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T07:02:27Z","timestamp":1563778947000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["The role of costing in the introduction and scale\u2010up of HIV pre\u2010exposure prophylaxis: evidence from integrating PrEP into routine maternal and child health and family planning clinics in western Kenya"],"prefix":"10.1002","volume":"22","author":[{"given":"D Allen","family":"Roberts","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruanne V","family":"Barnabas","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington Seattle WA USA"},{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Department of Medicine University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Abuna","sequence":"additional","affiliation":[{"name":"University of Washington in Kenya Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harison","family":"Lagat","sequence":"additional","affiliation":[{"name":"University of Washington in Kenya Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kinuthia","sequence":"additional","affiliation":[{"name":"Kenyatta National Hospital Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian","family":"Pintye","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron F","family":"Bochner","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Forsythe","sequence":"additional","affiliation":[{"name":"Avenir Health Glastonbury CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela B","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Tropical Hygiene and Medicine London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared M","family":"Baeten","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington Seattle WA USA"},{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Department of Medicine University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"John\u2010Stewart","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington Seattle WA USA"},{"name":"Department of Global Health University of Washington Seattle WA USA"},{"name":"Department of Medicine University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,22]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"UNAIDS.UNAIDS estimates.2018[cited 2018 Sep 15]. 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