The Costs of HIV Pre-exposure Prophylaxis (PrEP) Care Delivery: Comparing Specialists, Primary Care, and PrEP-RN

HIV prevention has evolved to include the provision of HIV medications to HIV-negative persons. Known as pre-exposure prophylaxis (PrEP), this intervention can reduce HIV acquisition by 96% when taken as prescribed. While previous reviews have established that PrEP is cost-effective, few have focused on the healthcare system delivery costs associated with PrEP. We undertake such a comparative analysis focusing on Ontario, Canada estimating the costs for an infectious disease physician, a primary care physician, and a nurse working in our nurse-led PrEP clinic (PrEP-RN). While the delivery of care by the nurse generated the least overall costs, we acknowledge that this would depend on how many patients breach the protocols established for nurse-led PrEP. We also highlight that targeting PrEP at persons who are at highest risk for HIV acquisition could make PrEP even more cost-effective than we estimated herein.