Abstract
BACKGROUND: As Kenya prepared to introduce the PrEP ring (a long-acting product used by women for HIV prevention), the need to understand the resources required became increasingly important. The aim of this study was to determine the costs and preferences of potential ring clients by conducting a normative cost analysis and a contingent valuation study (In the context of willingness to pay literature, "preference" is used to refer to an interest in a service or product with specified benefits). METHODS: The study incorporates two parts: 1) a normative costing to estimate potential costs of providing the PrEP ring and 2) a willingness to use/pay assessment to evaluate client preference for the PrEP ring. Oral PrEP program managers from 12 facilities were interviewed to assess the direct and indirect resources required to deliver PrEP ring services. 539 women were interviewed (including both younger and older women, as well as female sex workers) using a questionnaire to assess the strength of the expressed interest in PrEP ring use, as reflected by their contingent valuation of the product. Women were presented with payment cards from which they selected the most they would be willing to pay. The primary outcomes of the study were: 1) the annual cost of PrEP ring use and 2) the average willingness to pay for the PrEP ring. Women in the willingness to pay component were selected, using a convenience sample, with approximately equal numbers of oral PrEP users and clients from other health services. RESULTS: The cost to provide a full year of PrEP ring was US$206; 76% (US$156) of that cost was attributed to the PrEP rings. Of the respondents, 78% indicated some interest in using the PrEP ring; among those interested, 83% indicated some willingness to pay for it. Single women and women currently using oral PrEP expressed more interest in using the ring than women who were married or were not currently oral PrEP users. The median willingness to pay per visit was US$1.86. CONCLUSIONS: This analysis revealed that costs are predominantly driven by commodities. Attempts to further reduce the cost of the commodities could significantly reduce the overall cost of PrEP ring service. Approximately half the women were willing to pay up to US$2 per month for the PrEP ring. Since the demand for the PrEP ring appears to be higher among current oral PrEP users compared to non-users, women who have initiated oral PrEP but who are unable or unwilling to continue may be good candidates for PrEP ring use. The annual willingness to pay for the PrEP ring (US$11.16) was significantly lower than the ring's cost ($206 per year), which suggests that attempts to fully recover costs would present a significant barrier for Kenyan women and would minimize societal benefits.