The Challenge
An estimated 34 million people are living with HIV around the world. Although significant progress has been made in fighting the epidemic, 2.5 million people became newly infected with HIV in 2011, while another 1.7 million died from AIDS. In the face of the growing threat of HIV/AIDS, new prevention and treatment technologies could offer hope.
Pre-exposure prophylaxis for HIV (PrEP) is one of the most promising new technologies that could turn the tide of the HIV epidemic. With PrEP, HIV-negative people who are at high risk for infection use a daily antiretroviral (ARV)-based pill or gel to reduce their chances of becoming infected. Widespread use of pre-exposure prophylaxis for prevention could have a significant impact, reducing the spread of the epidemic and saving lives.
However, in developing countries with limited resources, there could be numerous obstacles preventing rapid uptake of ARV-based prevention, including the affordability of adopting such tools. In certain settings, the cost of providing PrEP could be prohibitive.
The Opportunity
To make an informed decision about whether to implement PrEP, country leaders, including national public health and finance officials and representatives of leading AIDS NGOs, must be able to assess the short- and long-term costs of PrEP and its effectiveness compared with alternative treatment and prevention options.
To assist such decision-makers, Georgetown University, with support from the Bill and Melinda Gates Foundation, formed a consortium comprising the Results for Development Institute (R4D), Imperial College London (ICL), the London School of Hygiene and Tropical Medicine (LSHTM) and other partners, to evaluate the cost-effectiveness of PrEP. Georgetown requested that R4D assist with data collection, analysis, and policy discussions surrounding country-specific PrEP costs and affordability.
Our Work
Since early 2013, R4D has been collaborating with ICL and leading AIDS NGOs in Kenya to estimate the incremental cost of PrEP in two phases: (1) as a part of an NGO-led demonstration project, during which oral PrEP will be provided to at-risk men and women in Nairobi; and (2) at a national scale.
Working in close collaboration with Imperial College, R4D has partnered with two Kenyan NGOs, LVCT and the Sex Workers Outreach Programme (SWOP), to design PrEP interventions for high-risk groups (including female sex workers and men having sex with men), estimate the costs of such programs, and create instruments for collecting cost data to inform the planning of the NGOs’ demonstration projects. This cost data will also be used as an input into an epidemiological model developed by ICL for evaluating PrEP cost-effectiveness in Nairobi, and will serve as the foundation for the second phase of work, which will assess the financial feasibility and sustainability of nation-wide PrEP rollout in Kenya. R4D has also assisted with project activities estimating the cost and cost-effectiveness of PrEP in Nigeria and South Africa.
The PrEP project builds on R4D’s expertise in AIDS costing and the use of cost-effectiveness analysis to aid decisions on resource allocation. R4D has honed its experience in this area through previous projects, including aids2031, the India AIDS options projects, and the AMFm malaria project, and ongoing work, including the Nigeria Saving One Million Lives fiscal space analysis and the Zimbabwe eMTCT costing project.
