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Background: There has been massive scale-up of HIV prevention interventions by the Zambian government especially among adolescents and young people. One such intervention is Pre-Exposure Prophylaxis (PrEP), and its implementation may hinge on the cost compared to the benefits. While most studies and reviews on PrEP have focused on cost-effectiveness, very few studies have been done on the cost of delivering PrEP in adolescents and young people. Such data are critically needed to guide national health policy in areas of preventing HIV/AIDS in adolescents and young people.
Methods: A cost analysis of PrEP using micro-costing or ingredients approach to estimate the required resources for effective PrEP among adolescents and young people data between October 2020 and September 2021. All expenditure data was collected from programmatic activity records at Kalingalinga Health Centre and all projected costs were obtained from Ministry of Health (MOH) implementation programme from a provider perspective. We estimated total and unit costs in 2021 United States Dollars (USD) from MOH reports. Data was analysed using a standardized cost collection template in Microsoft Excel-based format.
Results: The total number of the clients that accessed PrEP for the period under review October 2020 and September 2021, were 941 of which 64% (623/941) were adults and 34% (318/941) were Adolescents and Young People (AYP). Of the 318 AYP, 280/318 females were (88%) while males 38/318 (12%). The total annual program cost of providing PrEP at Kalingalinga health centre over 12 months of 941 clients was $200,964.99 and $67,913.57 for the AYP, with a unit cost of $213.57 per client-year. The main drivers of costs were PrEP medication, medical personnel salaries, and allowances, building and administrative/supervision costs, laboratory test kits and surgical materials respectively. The major cost component being 78.87% for PrEP medication, followed by building maintenance at 3.47%.
Conclusion: This study suggests that the annual program cost of implementing PrEP among AYP at Kalingalinga health center was$67,913.78. More analysis of the cost associated with other clinics, monitoring and technical support should be included to assess cost-effectiveness of delivering PrEP to adolescents and young people.
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