Evaluating the Cost of Scaling PrEP Access through Novel Delivery (EXPAND)

Research Themes: Cost and Budget Modelling Costs, Cost-Effectiveness and Benefits of HIV Care and Treatment HIV Treatment Outcomes and Guidelines

Oral pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention tool. Despite being recommended by the WHO since 2015, however, uptake and persistence remain limited. There is a dearth of evidence-based interventions to improve PrEP uptake and persistence in sub-Saharan Africa and the full costs of PrEP programs implemented in routine care settings remain largely unknown.

The EXPAND project is an economic evaluation to estimate the provider and client costs, cost per outcome, and potential budget impact associated with three implementation research project that are implementing novel PrEP delivery platforms in South Africa.

Each of the PrEP implementation projects is unique in its service delivery model, target population, and geographic setting. The economic evaluation will not draw direct comparisons between the different models but rather will generate clear cost estimates highlighting the cost drivers in each model and how resource use is related to the outcomes achieved. This information will then be used to estimate the financial impact of implementing the interventions at scale, focusing on their affordability within the South African health system’s resource constraints.

EXPAND will answer the following research questions for each model:

  1. What is the cost to the provider (Department of Health and implementing partners) of providing PrEP services per client per covered month? (Component 1: Provider cost outcome analysis)
  2. What is the cost to the client of accessing these services and do client outcomes vary with client costs? (Component 2: Client costing and outcome validation)
  3. What aspects of the models are preferred by potential PrEP clients and what is their potential willingness to pay for specific model attributes? (Component 3: Choice determinants of PrEP service delivery)
  4. What impact would the adoption and scale up have on the national PrEP program and South African health budget? (Component 4: Budget impact analysis)

This project also includes a cross-cutting component focused on local capacity building to conduct costing and economic evaluations.

Funded by


HE2RO staff involved

Dr. Jacqui Miot Dr. Lawrence Long Professor Sydney Rosen Cheryl Hendrickson Refiloe Motaung Sharon Kgowedi Constance Mongwenyana Nkamoheleng Mkhwanazi

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