Understanding the cost of pharmacy-delivered HIV pre- and post-exposure prophylaxis service delivery in Kenya: findings from pilot studies

Abstract Background Private pharmacies are a primary access point for health services in many African countries. Leveraging private-sector pharmacies to deliver HIV prevention services, including pre- and post-exposure prophylaxis (PrEP/PEP), may expand the reach of these services. Understanding delivery costs is necessary to inform scale-up. Methods We used data from two pilot studies conducted in Kisumu County, Kenya. In the first pilot, pharmacy providers at 12 pharmacies delivered free PrEP/PEP to eligible clients (≥ 18 years) using a prescribing checklist with remote clinician oversight; PrEP/PEP drugs were donated from government stock. Using microcosting, we estimated the economic and financial costs from the provider’s perspective for: (1) subsidized delivery (donated commodities excluded), and (2) non-subsidized delivery (donated commodities included). We also assessed client willingness to pay for PrEP services at pharmacies using PrEP client survey data. In the second pilot, pharmacy providers at 20 pharmacies delivered HIV testing services. We assessed providers’ anticipated willingness to deliver PrEP services using provider survey data. Result From February to July 2022, pharmacies in the first pilot recorded 1, 564 PrEP/PEP visits, and initiated 691 clients on PrEP. Among clients eligible to continue PrEP at the pharmacy, 69% (479/691) refilled at least once. We collected 694 surveys from PrEP clients. From March to June 2022, 40 providers in the second pilot completed surveys. The estimated economic (financial) costs per client-month on PrEP were 3. 66 (2. 17) USD for subsidized and 13. 23 (11. 74) USD for non-subsidized delivery, and for PEP were 3. 66 (2. 15) USD for subsidized and 10. 75 (9. 24) USD for non-subsidized delivery. Most PrEP clients (83%, 575/691) expressed willingness to pay for pharmacy-delivered PrEP services; the median amount they were willing to pay per visit was 3. 30 USD (IQR 1. 60-4. 10 USD), which exceeded the median maximum amount providers said they would charge per visit (2. 40 USD, IQR 1. 60-4. 10 USD). Conclusions When subsidized with drugs from government stock, pharmacies are a low-cost platform for delivering PrEP and PEP services in Kenya. Client out-of-pocket payments could help sustain pharmacy PrEP/PEP delivery at scale, enabling broader coverage of HIV prevention services.