FINANCIAL COSTS OF PROVIDING ORAL PRE- AND POST-EXPOSURE PROPHYLAXIS VIA PHARMACIES IN KENYA
Author(s)
SHIVEN BHARDWAJ, PharmD, MAS1, Tabitha Kareithi, BPharm2, Victor Omollo, MBChB, MPH3, Catherine Kiptinness, MPH2, Patricia A. Ong'wen, MBBS, MPH4, Micah O. Anyona, MS4, paul Gathii, BS4, Gabriel Macharia, BA4, Rachel C. Malen, MPH5, Kendall Harkey, MPH5, Daniel Were, PhD, MPH4, elizabeth bukusi, MBChB, M.Med, MPH, PhD, PGD3, Kenneth Ngure, PhD6, Katrina F. Ortblad, PhD5, Monisha Sharma, PhD7;
1University of Washington, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Seattle, WA, USA, 2Kenya Medical Research Institute, Partners in Health, Research, and Development, Centre for Clinical Research, Nairobi, Kenya, 3Kenya Medical Research Institute, Centre for Microbiology Research, Kisumu, Kenya, 4Jhpiego Kenya, Nairobi, Kenya, 5Fred Hutchinson Cancer Center, Public Health Sciences Division, Seattle, WA, USA, 6Jomo Kenyatta University of Agriculture and Technology, School of Public Health, Nairobi, Kenya, 7University of Washington, Department of Global Health, Seattle, WA, USA
1University of Washington, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Seattle, WA, USA, 2Kenya Medical Research Institute, Partners in Health, Research, and Development, Centre for Clinical Research, Nairobi, Kenya, 3Kenya Medical Research Institute, Centre for Microbiology Research, Kisumu, Kenya, 4Jhpiego Kenya, Nairobi, Kenya, 5Fred Hutchinson Cancer Center, Public Health Sciences Division, Seattle, WA, USA, 6Jomo Kenyatta University of Agriculture and Technology, School of Public Health, Nairobi, Kenya, 7University of Washington, Department of Global Health, Seattle, WA, USA
OBJECTIVES: Private pharmacies are commonly accessed for sexual and reproductive health services in Kenya. Leveraging pharmacies for provision of oral pre- and post-exposure prophylaxis (PrEP and PEP) could increase HIV prevention coverage. The success of this model depends on its affordability, but data on PrEP and PEP provision costs are lacking.
METHODS: We conducted microcosting within the Pharm PrEP cRCT (NCT05842122); a cluster-randomized trial in 45 intervention pharmacies across Kenya that assessed three strategies: A1) client-sustained delivery: pharmacy provider-led with client cost-sharing of ~$2 USD/visit, A2) implementor-sustained delivery: pharmacy provider-led without cost-sharing, and A3) counselor-supported delivery: pharmacy-embedded counselor-led without cost-sharing. In the latter two strategies, implementors reimbursed pharmacies ~$2 USD/visit (implementor-supported) or $1 USD/visit (counselor-supported). At 19 representative pharmacies across strategies, we conducted microcosting and time-and-motion observations. Total costs were aggregated to derive the average cost per visit based on observed trial volumes.
RESULTS: From June 2023-April 2025, 5,808 clients were enrolled (A1: 843; A2: 2,254; A3: 2,278). The costs per PrEP and PEP visits were highest in the counselor-supported arm (PrEP and PEP: $30), followed by the client-sustained (PrEP: $15; PEP: $14) and implementor-sustained (PrEP and PEP: $7) arms. The substantially higher cost in the counselor-supported arm was driven by placement of full-time pharmacy-based counsellors. Other cost contributors were provider training (A1: $4.03; A2: $1.79; A3: $1.78) and overhead (A1: $5.06, A2: $1.70, A3: $1.71). The implementor-supported arm achieved the lowest costs per visit as fixed costs were distributed over a high client volume.
CONCLUSIONS: Pharmacy provider-led PrEP/PEP delivery without client cost-sharing is the lowest cost model for expanding PrEP provision in this novel setting. Provider-led models are more scalable and affordable than counselor-supported models.
METHODS: We conducted microcosting within the Pharm PrEP cRCT (NCT05842122); a cluster-randomized trial in 45 intervention pharmacies across Kenya that assessed three strategies: A1) client-sustained delivery: pharmacy provider-led with client cost-sharing of ~$2 USD/visit, A2) implementor-sustained delivery: pharmacy provider-led without cost-sharing, and A3) counselor-supported delivery: pharmacy-embedded counselor-led without cost-sharing. In the latter two strategies, implementors reimbursed pharmacies ~$2 USD/visit (implementor-supported) or $1 USD/visit (counselor-supported). At 19 representative pharmacies across strategies, we conducted microcosting and time-and-motion observations. Total costs were aggregated to derive the average cost per visit based on observed trial volumes.
RESULTS: From June 2023-April 2025, 5,808 clients were enrolled (A1: 843; A2: 2,254; A3: 2,278). The costs per PrEP and PEP visits were highest in the counselor-supported arm (PrEP and PEP: $30), followed by the client-sustained (PrEP: $15; PEP: $14) and implementor-sustained (PrEP and PEP: $7) arms. The substantially higher cost in the counselor-supported arm was driven by placement of full-time pharmacy-based counsellors. Other cost contributors were provider training (A1: $4.03; A2: $1.79; A3: $1.78) and overhead (A1: $5.06, A2: $1.70, A3: $1.71). The implementor-supported arm achieved the lowest costs per visit as fixed costs were distributed over a high client volume.
CONCLUSIONS: Pharmacy provider-led PrEP/PEP delivery without client cost-sharing is the lowest cost model for expanding PrEP provision in this novel setting. Provider-led models are more scalable and affordable than counselor-supported models.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE21
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Infectious Disease (non-vaccine)