Microcosting the optimization of PrEP implementation among sexual and gender minority individuals with a substance...

Substance Use Disorder (SUD) increases HIV risk and is often a barrier to advancement along the PrEP Care Continuum. In the United States ~ 40,000 new HIV diagnoses occur annually, the majority among sexual and gender minorities who use substances. Insufficiently treated HIV and SUD results in substantial costs to society. Effective strategies that focus on SUD as part of a client-centered approach to improve PrEP engagement and address social determinants of health (SDoH), are critical. Understanding resources/cost requirements is important to know for prospective sites.

The parent R01 was a single-site, randomized stepped-care and cost-effectiveness trial of Assisted Service Knowledge (A.S.K)-PrEP vs. standard of care (SOC), where "non-responders" in the A.S.K-PrEP arm were stepped to additional attention for SUD via contingency management (CM), resulting in three strategies against SOC (A.S.K-PrEP; A.S.K-PrEP + CM; A.S.K-PrEPàCM alone). Resources needed to implement and sustain each strategy were captured as part of a detailed microcosting analysis. Resources were categorized as fixed start-up, time-dependent, or variable, and organized within the implementation or sustainment phase. Costs were assigned using nationally representative prices.

Start-up costs (first year costs) were $25,958 and time-dependent costs (annually based) were $68,442 across strategies. Variable costs (annually based) differed across strategies resulting in $31,716 for A.S.K-PrEP alone, $31,994 for A.S.K-PrEP + CM and $30,271 for CM alone. The per-participant intervention cost was $55 for Standard of Care, $104 for A.S.K-PrEP alone, $73 for A.S.K-PrEP + CM, and $16 for CM alone.

This study provides key insights into the "real-world" resource/cost requirements for implementing and sustaining each A.S.K.-PrEP strategy. Our results and publicly available budget impact tool provide support for potential stakeholders to ensure both feasibility and long-term sustainability for PrEP uptake and adherence for sexual and gender minority individuals with a SUD.

NCT05934877 and was registered on 05/23/23 as a clinical trial.