Out-of-pocket Expenses and Time Spent on Clinic Visits Among HIV Pre-exposure Prophylaxis Users and Other Clinic Attendees in Eswatini

Abstract

User costs constitute a barrier to the uptake of HIV pre-exposure prophylaxis (PrEP), but their magnitude appears rarely assessed. In this prospective observational study, we assessed self-reported out-of-pocket expenses (OOPE) and time spent on clinic visits during a PrEP demonstration project in Eswatini. At six public primary care clinics, 240 PrEP users and other clinic attendees were interviewed after a clinic visit. Among the 79.2% of clinic attendees reporting any medical OOPE (e.g., expenses for consultations or drugs) and/or non-medical OOPE (e.g., expenses for transport, food, or phone use), the median total OOPE was $1.36 (IQR 0.91–1.96). Non-medical OOPE occurred mostly due to transport expenses. The median travel time for a clinic visit was 1.0 h (IQR 0.67–2.0). The median time spent in the clinic was 2.0 h (IQR 1.15–3.0). The median opportunity cost of a clinic visit was $7.54 (IQR 5.42–11) when valuing time spent on a clinic visit with Eswatini’s per-capita gross domestic product. Our findings can guide measures to reduce the user costs of PrEP in Eswatini and other contexts in which oral PrEP is provided through health care facilities.

Preferences for Long-Acting PrEP Products Among Women and Girls: A Quantitative Survey and Discrete Choice Experiment in Eswatini, Kenya, and South Africa

“…In addition to supply-side barriers, including policies limiting PrEP access to narrowly defined groups, subsequent research has identified numerous demand-side barriers to oral PrEP uptake and continuation among women and girls. These include stigma related to sexual activity (especially among adolescent girls) [ 12 , 13 ], assumptions around one’s HIV status related to taking antiretrovirals [ 14 ], pill burden [ 15 , 16 ], the need for regular clinic visits [ 17 , 18 ], low perceived risk of HIV [ 19 , 20 ], and service delivery largely centralized in HIV, STI, or key-population-focused clinic spaces and programs where girls and women don’t often seek care [ 21 ].…”

Online-Mediated HIV Pre-exposure Prophylaxis Care and Reduced Monitoring Frequency for Men Who Have Sex With Men: Protocol for a Randomized Controlled Noninferiority Trial (EZI-PrEP Study)

“…In-clinic PrEP care faces several challenges that stem from the recommended frequency of monitoring visits (every 3 months). Clients might have to take time off from work, school, or family obligations, and may incur travel costs for attending in-clinic visits [13][14][15][16][17]. Persons interested in PrEP may also feel burdened with perceived stigma [18,19], cultural or social insensitivity [16,20,21], and lack of privacy [14,15] at the clinic.…”