Costs of Providing Preexposure Prophylaxis for HIV Prevention at Community Health Centers in the United States

Abstract

Objective: Preexposure prophylaxis (PrEP) is recommended for people at risk of acquiring HIV. We assessed billable costs associated with PrEP delivery at community health centers. Methods: The Sustainable Health Center Implementation PrEP Pilot (SHIPP) study is an observational cohort of people receiving daily oral PrEP at participating federally qualified health centers and other community health centers. We assessed health care utilization and billable costs of providing PrEP at 2 health centers, 1 in Chicago, Illinois, and 1 in Washington, DC, from 2014 to 2018. The health centers followed the clinical practice guidelines for PrEP provision, including regular visits with health care providers and ongoing laboratory monitoring. Using clinic billing records and Current Procedural Terminology (CPT) coding, we retrospectively extracted data on the frequency and costs (in 2017 US dollars) of PrEP clinic visits and laboratory screening, for each patient, for 12 months since first PrEP prescription. Results: The average annual number of PrEP clinic visits and associated laboratory screens per patient was 5.1 visits and 25.2 screens in Chicago (n = 482 patients) and 5.4 visits and 24.8 screens in Washington, DC (n = 56 patients). The average annual PrEP billable cost per patient was $583 for clinic visits and $1070 for laboratory screens in Chicago and $923 for clinic visits and $1018 for laboratory screens in Washington, DC. The average annual total cost per patient was $1653 (95% CI, $1639-$1668) in Chicago and $1941 (95% CI, $1811-$2071) in Washington, DC. Conclusions: Our analysis, which provides PrEP billable cost estimates based on empirical data, may help inform health care providers who are considering implementing this HIV prevention strategy.

Characterizing Interest in and Uptake of Preexposure Prophylaxis for HIV Prevention Among Men in a US State Correctional System

“…The study's results highlight numerous barriers at the individual, interpersonal, and institutional levels to PrEP uptake among populations experiencing incarceration based on an adapted socioecological model, which serves as an organizational framework for contextualizing study findings on barriers to PrEP uptake 19,29 …”

“…The study seeks to inform the implementation of PrEP care to meet the needs of incarcerated populations, which can potentially reduce HIV incidence on a population-wide scale. To this end, the study team has published an adapted version of the socioecological model to present the multilevel barriers to PrEP implementation, ranging from the individual, interpersonal to the structural level, for both the correctional setting and the community setting 19 . The use of the socioecological model offers the potential to better understand the factors that impact PrEP uptake among incarcerated men at increased risk of HIV acquisition.…”