Human resource needs and costs for HIV pre-exposure prophylaxis provision in nurse-led primary care in Eswatini and opportunities for task sharing﻿

Table 4 Predicted human resource costs for a PrEP initiation and a PrEP follow-up visit with task shifting and sharing

Scenario	Pre-PrEP counseling	HIV risk assessment	PrEP eligibility screening	PrEP initiation	Follow-up counseling	Blood testing	PrEP initiation visit ($)^#	PrEP follow-up visit ($)^#
Base case^†	Nurse	Nurse	Nurse	Nurse	Nurse	Nurse	4.47 [1.24–11]	2.31 [0.71–4.98]
Scenario 1^†	Nursing sister	Nursing sister	Nursing sister	Nursing sister	Nursing sister	Nursing sister	7.27 [2.43–15]	3.76 [1.40–6.87]
Scenario 2^‡	HTS counselor	HTS counselor	Nurse	Nurse	Nurse	Phlebotomist	2.89–4.25 [0.83–9.19]	1.44–2.60 [0.35–5.44]
Scenario 3^‡	HTS counselor	HTS counselor	Nurse	Nurse	Nurse	HTS counselor	2.85–4.21 [0.83–9.04]	1.20–2.56 [0.30–5.29]
Scenario 4^‡	HTS counselor	HTS counselor	Nurse	Nurse	Nurse assistant	HTS counselor	2.85–4.21 [0.83–9.04]	1.06–1.86 [0.30–3.28]
Scenario 5^‡	Peer supporter	Peer supporter	Nurse	Nurse	Nurse assistant	HTS counselor	2.30–4.06 [0.62–8.51]	1.06–1.86 [0.30–3.28]

[] = uncertainty interval. HCW = health care worker. HTS = HIV testing services. Peer supporter = mother-to-mother mentor or expert client. ^†Uninterrupted workflow possible when tasks are fully shifted between HCW cadres. ^‡Interrupted workflow when tasks are shared among HCW cadres. ^#Cost range with fixed time cost based on lowest and highest HCW cadre salary when different HCW cadres provide PrEP activities. Scenarios 1–3 represent practiced task shifting and task sharing. Scenarios 4 and 5 represent additional opportunities for task sharing. Time needs estimated based on Table 2 Model 2. Time needs estimated based on Table 2 Model 1 are provided in Additional file 1: Supplement A Table S7

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