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Introduction Oral pre-exposure prophylaxis (PrEP) is increasingly being implemented in sub-Saharan Africa. Adolescent girls and young women (AGYW) in Kenya contribute more than half of all new infections among young people aged 15–24 years, highlighting the need for evidence on the cost of PrEP in real-world implementation to inform the budget impact, cost-effectiveness, and financial sustainability of PrEP programs. Methods We estimated the cost of delivering PrEP to AGYW enrolled in a PrEP implementation study in two family planning clinics in Kisumu county, located in western Kenya. We derived total annual costs and the average cost per client-month of PrEP by input type (variable or fixed) and visit type (initiation or follow-up). We estimated all costs as implemented in the study, and under implementation by the Kenyan Ministry of Health (MoH), both at the program volume observed and if the facilities were delivering PrEP at full capacity (scaled-MoH). Results For the costing period between March 2018 and March 2019, 615 HIV-negative women contributed 1,128 (502 initiation and 626 follow-up) visits. The average cost per client-month of PrEP dispensed per study protocol and per the MoH scenario was $28.92 and $14.52, respectively. If the MoH scaled the program so that facilities could see PrEP clients at capacity, the average cost per client-month of PrEP was $10.88. Medication costs accounted for the largest proportion of the total annual costs (48% in MoH scenario and 65% in the scaled-MoH scenario). Conclusions Using data from a PrEP implementation program, we found that the cost per client-month of PrEP dispensed is reduced by 62% if PrEP delivery at the two clinics is scaled up by the MoH. Our findings are valuable for informing local resource allocation and budgetary cost projections for scale-up of PrEP delivery to AGYW. Additionally, previous cost-effectiveness studies have been limited by the use of fixed assumptions of the cost of PrEP per person-month. Our study provides cost estimates from practical data which will better inform cost-effectiveness and budget impact analyses.

Background Although ART is one of the most celebrated treatment advances in the recent medical history, a large proportion of eligible people were not receiving ART and one fifth of patients who started ART were no longer in care/treatment after one year due to various reasons in low and middle-income countries. The objective of this study is to systematically review to identify the health system related factors associated to ART treatment adherence among adults living with HIV/AIDS in developing countries. Methods Reviewer systematically searched MEDLINE and EMBASE databases (1996 to August 2011) and web-based information. The reference lists of included papers were also checked, with citation searching on key papers. The studies examining health system factors associated with ART treatment adherence were considered for inclusion. Quality assessment and data extraction were performed. Results A total of 622 articles were identified, and 14 studies met the inclusion criteria, representing in 9 qualitative, 3 quantitative and 2 mixed methods and 11 countries out of 152 developing countries. Twenty-four health system themes were found associated to ART non adherence and 18 themes were found as facilitator for adherence.Author's conclusion: The identified health system factors, service providers including clinical team can use this information to engage in open discussion with patients and PLWHAs to promote ART treatment adherence and identify issues within their own health centres. Indeed, HIV patients from developing are found very sensitive in utilisation of health services not only on the amount/ numbers of services they received, but also on time, cost, place, information and quality. Thus the responsibility of adherence shifts to the health service provider leaving patients with different choices and options. coSt analySiS oF RecRuitment StRategieS uSed in tHe PaRtneRS PRe-exPoSuRe PRoPHylaxiS (PReP) clinical tRial at KiSumu Site, Kenya