The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to$655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35–65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia

Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up

INTRODUCTION: Daily pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but not yet widely deployed in sub-Saharan Africa. We describe how Zambia developed PrEP health policy and then successfully implemented national PrEP service delivery. POLICY DEVELOPMENT: Zambia introduced PrEP as a key strategy for HIV prevention in 2016, and established a National PrEP Task Force to lead policy advocacy and development. The Task Force was composed of government representatives, regulatory agencies, international donors, implementation partners and civil society organisations. Following an implementation pilot, PrEP was rolled out nationally using risk-based criteria alongside a national HIV prevention campaign. NATIONAL SCALE-UP: In the first year of implementation, ending September 2018, 3626 persons initiated PrEP. By September 2019, the number of people starting PrEP increased by over sixfold to 23 327 persons at 728 sites across all ten Zambian provinces. In the first 2 years, 26 953 clients initiated PrEP in Zambia, of whom 31% were from key and priority populations. Continuation remains low at 25% and 11% at 6 and 12 months, respectively. LESSONS LEARNT: Risk-based criteria for PrEP ensures access to those most in need of HIV prevention. Healthcare worker training in PrEP service delivery and health needs of key and priority populations is crucial. PrEP expansion into primary healthcare clinics and community education is required to reach full potential. Additional work is needed to understand and address low PrEP continuation. Finally, a task force of key stakeholders can rapidly develop and implement health policy, which may serve as a model for countries seeking to implement PrEP

Introduction: Toward an Engaged Feminist Heritage Praxis

We advocate a feminist approach to archaeological heritage work in order to transform heritage practice and the production of archaeological knowledge. We use an engaged feminist standpoint and situate intersubjectivity and intersectionality as critical components of this practice. An engaged feminist approach to heritage work allows the discipline to consider women’s, men’s, and gender non-conforming persons’ positions in the field, to reveal their contributions, to develop critical pedagogical approaches, and to rethink forms of representation. Throughout, we emphasize the intellectual labor of women of color, queer and gender non-conforming persons, and early white feminists in archaeology

African Archaeological Journals and Social Issues 2014–2021

The two waves of reflexivity in archaeology are the identity politics of archaeologists and stakeholder politics. These social issues are considered in this article through the perspective of three African archaeological journals produced from 2014 to 2021. Identity politics is examined through a quantitative analysis of authorship, book reviewing, and the countries covered. I conclude that parity of gender authorship—assuming 61% male and 39% female archaeologists—has been achieved by the African Archaeological Review, Journal of African Archaeology, and Azania. In book reviewing, this is less so. The geographical coverage across the three journals shows lacunae. Stakeholder politics is most visible in book reviews and special issues. Journal ethics and goals and the final topics of open access and other ways of broadening the pool of authors, reviewers, and accessibility are offered

Antiques - Objects of Lateral Cycling?

After a brief discussion of the various ways the use-life of an object can be prolonged, an additional method is illustrated, that of adjacent cycling, Antiques are used as examples. The role of antiques as status symbols is suggested to be the reason for their prolonged use-life. The archaeological implications of adjacent cycling also are discussed

The status of women's athletics on the University of Arkansas campus

Report on the status of women's athletics at the University of Arkansas

Recent Reflections on the Sociology of Archaeology: Introduction

Nothing in the past 60 years has nullified the impact of the social positioning of archaeologists and the discipline in the creation of archaeological knowledge [...

Antiques - Objects of Lateral Cycling?

After a brief discussion of the various ways the use-life of an object can be prolonged, an additional method is illustrated, that of adjacent cycling, Antiques are used as examples. The role of antiques as status symbols is suggested to be the reason for their prolonged use-life. The archaeological implications of adjacent cycling also are discussed