Evaluating the Costs of an Integrated PrEP and SRH Model Delivered in South African Community Pharmacies and Online: Evidence from an Implementation Study Project
1
Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
2
Ezintsha, Faculty of Health Sciences,, University of the Witwatersrand, Johannesburg, South Africa
3
Department of Global Health , School of Public Health, Boston University, Boston, United States
Popul. Med. 2026;8(Supplement Supplement 1):A3607
ABSTRACT
BACKGROUND:
Despite oral PrEP being freely available at primary care clinics for several years, South Africa still faces new HIV acquisitions annually. Community pharmacies and online platforms are novel delivery models able to expand access and reach; however, implementation costs in South Africa are unknown. We estimate the costs of delivering oral PrEP alongside sexual and reproductive health (PrEP+) services in local pharmacies and online.
METHODS:
We conducted a cost analysis of a South African implementation project which offered oral PrEP+ services in 10 community pharmacies and via online between June 2023-May 2025. Using a provider perspective ingredients-based approach, we estimated the average cost per PrEP initiation and follow-up visit. Site-level costs were allocated to visits based on the average number of visits per month per site. 2023-2024 project expense records and invoices were categorized into non-variable and variable resource inputs. Costs are reported in US dollars ($) (18.00 South African Rand/$).
RESULTS:
Project sites had 1,933 and 3,277 oral PrEP initiation and follow-up visits, respectively. Average cost/ initiation visit in pharmacies was $174.89 with costs varying by site. Online service had a higher average cost/initiation visit of $285.42. Initiation visit non-variable costs were driven by demand creation (37%) and staff costs (34%) in pharmacies, demand creation costs were the cost driver for online. variable costs were driven by initiation labs in both models. Average cost/follow-up visit in pharmacies was $147.99, driven by staff costs (75%) due to low monthly visit volumes. Average follow-up visit cost in the online model was $111.71 driven by lab costs needed for remote seroconversion monitoring.
CONCLUSIONS:
The costs of delivering oral PrEP through community pharmacies and online in this implementation study are variable and sensitive to client volume. Substantial cost reductions are anticipated in a real-world implementation where models are integrated into existing systems.
Despite oral PrEP being freely available at primary care clinics for several years, South Africa still faces new HIV acquisitions annually. Community pharmacies and online platforms are novel delivery models able to expand access and reach; however, implementation costs in South Africa are unknown. We estimate the costs of delivering oral PrEP alongside sexual and reproductive health (PrEP+) services in local pharmacies and online.
METHODS:
We conducted a cost analysis of a South African implementation project which offered oral PrEP+ services in 10 community pharmacies and via online between June 2023-May 2025. Using a provider perspective ingredients-based approach, we estimated the average cost per PrEP initiation and follow-up visit. Site-level costs were allocated to visits based on the average number of visits per month per site. 2023-2024 project expense records and invoices were categorized into non-variable and variable resource inputs. Costs are reported in US dollars ($) (18.00 South African Rand/$).
RESULTS:
Project sites had 1,933 and 3,277 oral PrEP initiation and follow-up visits, respectively. Average cost/ initiation visit in pharmacies was $174.89 with costs varying by site. Online service had a higher average cost/initiation visit of $285.42. Initiation visit non-variable costs were driven by demand creation (37%) and staff costs (34%) in pharmacies, demand creation costs were the cost driver for online. variable costs were driven by initiation labs in both models. Average cost/follow-up visit in pharmacies was $147.99, driven by staff costs (75%) due to low monthly visit volumes. Average follow-up visit cost in the online model was $111.71 driven by lab costs needed for remote seroconversion monitoring.
CONCLUSIONS:
The costs of delivering oral PrEP through community pharmacies and online in this implementation study are variable and sensitive to client volume. Substantial cost reductions are anticipated in a real-world implementation where models are integrated into existing systems.
| eISSN: | 2654-1459 |
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