The cost of providing HIV prevention drugs in Kenya could go as low as Sh1,000 per person every month, a new assessment shows.
This makes the pre-exposure prophylaxis a cost-effective way to prevent HIV, especially among key populations who are at high risk.
The analysis by multiple researchers shows that in 2017, when Kenya introduced PrEP in 25 HIV-1 care clinics, about 2,567 persons were initiated.
The total financial cost to the Ministry of Health was Sh9,988,221 ($91,175), translating to an average of Sh1,129.46 ($10.31) per person per month.
The majority (69 per cent) of financial costs were attributable to the drugs, followed by administrative supplies (17 per cent) and training (nine per cent).
“Negotiation of lower prices may improve the financial feasibility of this highly effective prevention method,” the researchers recommend.
Their findings, titled “Low costs and opportunities for efficiency: a cost analysis of the first year of programmatic PrEP delivery in Kenya’s public sector”, are published in the BMC Health Services Research journal.
This is the first costing analysis of public sector PrEP provision in HIV care clinics in Kenya, where the majority of PrEP clients receive services.
Kenyan researchers who took part in the study were from Kemri, Jomo Kenyatta University of Agriculture and Technology, the Ministry of Health and Partners in Health and Research Development, a Nairobi-based non-profit organisation.
The researchers said although PrEP is provided free of charge, clients incurred approximately Sh500-Sh700 in direct non-medical costs per clinic visit, potentially representing an important barrier to PrEP uptake and continuation.
“The cost to clients of monthly refills was particularly high; efforts to enact a quarterly visit schedule would reduce the cost burden to clients, as well as, to a lesser extent, the healthcare system.”
PrEP only needs to be taken consistently for the period users are at risk of infection. In contrast, delivering ARVs to people living with HIV costs about Sh20,000 a year. The drugs must be taken for life.
At least 40,000 Kenyans, mostly young people, contract HIV every year.
If taken as prescribed, the pre-exposure prophylaxis drugs provide 100 per cent protection against HIV.
However, a separate analysis by the Ministry of Health this year showed that because of poor adherence, 65 Kenyans have contracted HIV while consistently taking the PrEP since 2017.
Nam-Aidsmap, a UK-based charity, in its analysis of the findings, said some could have acquired HIV during a period of poor adherence or drug supply interruption.
Kenya rolled out PrEP as a national programme in the public sector in May 2017, becoming the first African country to do so.
The last count done in Kenya in 2019 showed that 25,000 people were using PrEP.
Medical experts say there is no consistent data on how many people are using PrEP, as a significant number take it only to have risky and unprotected sex and then drop out.
The 65 cases happened between 2017 and 2021, but there could be more people who have become infected and were not documented.
The MoH findings were presented online last month at the 11th International Aids Society Conference on HIV Science.