Financial cost of a PrEP program among adolescent men who have sex with men and transgender women in Brazil


BACKGROUND: PrEP is offered as a taxpayer's money program since 2017 for adults 18 years old (yo). or older. Moreover, PrEP is cost-effective in preventing HIV infections in adults. Nevertheless, it is important to expand PrEP to youth at high risk of HIV such as adolescent men who have sex with men (aMSM) and transgender women (aTGW). We aimed to estimate the costs of scaling-up PrEP to adolescents aged 15 to 17 years in Brazil.
METHODS: PrEP1519 is a demonstration cohort study of daily TDF/FTC as PrEP among aMSM and aTGW aged 15-19 yo. It is ongoing in three Brazilian capital cities (Salvador, São Paulo, and Belo Horizonte). We used data from two cities of PrEP1519, the Brazilian National Health System (SUS) databases for prices of commodities, and conducted interviews with health providers to assess the use of resources. We assessed the costs into three main categories: set-up, capital, and recurrent costs. Set-up and capital costs were annualized using a discount rate of 5%. Costs were estimated as total costs to the health system and average costs per patient.
RESULTS: The total cost of PrEP in Salvador was estimated at US$ 272 thousand and in São Paulo at US$ 437 thousand, with an average cost per patient of US$ 860 and US$ 783, respectively. Recurrent costs responded to 87% of the total costs in Salvador, and 80% of the costs in São Paulo. The components of demand creation of the PrEP1519 study (through social media and other networks), and peer-counseling time are the main cost categories for PrEP to be fully scaled up in theSUS.
CONCLUSIONS: Although the cost per patient in the two Brazilian settings is considerably high, most of these costs are already integrated into theSUS, and at scale, cost per patient tends to decrease substantially. Demand creation and peer counseling are the elements that would require the greatest cost increase to expand the PrEP program and to improve HIV treatment adherence as an added value. Further analysis is being conducted to estimate the cost per patient when PrEP is offered at scale.

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