Cost of implementing HIV pre-exposure prophylaxis at community-based clinics in Indonesia.

INTRODUCTION: Currently, Indonesia still has one of the highest rates of new HIV/AIDS infections among countries in Asia and the Pacific region. The WHO has recommended pre-exposure prophylaxis (PrEP) as an additional HIV epidemic prevention step, which has been applied globally and related to the reduction in the number of HIV cases. However, information on the cost of implementing PrEP is rarely available in developing countries, especially in Southeast Asia. Designing a cost-effective approach to scale up PrEP and to estimate the potential budget impact requires information on the cost of implementing PrEP. This study aims to estimate the cost of implementing PrEP at community-based clinics in Indonesia. METHODS: We collected healthcare and non-healthcare/client costs from nine community-based clinics in various cities/districts in Indonesia. The healthcare costs included data on resource utilisation and costs to deliver PrEP, divided into recurrent and capital costs using a discount rate of 3%. Non-healthcare costs included out-of-pocket costs (e.g., transportation, meals) and productivity loss by clients and accompanying person(s) in accessing PrEP. On average, we interviewed 27 clients/clinic. RESULTS: The annual cost of providing PrEP per client is US $365.03, 39% lower than the yearly cost of antiretroviral treatment (ART) per person (approximately US $600). Drugs and non-healthcare costs contribute approximately 67% of the cost. The cost of PrEP amounts to US $292,756.45/year, covering 802 clients. The non-healthcare cost per visit at all sites never reaches more than 10% of the average monthly household expenditure. CONCLUSIONS: The cost of providing PrEP per person is approximately US $365 and is 39% lower than the annual cost of ART per person. Lowering the cost of PrEP ARV drugs would reduce the cost. Scaling up PrEP should recognise this cost structure and strive to reach economies of scale as the intervention gains more clients while simultaneously controlling new HIV infections.

Germination effects on the physicochemical properties and sensory profiles of velvet bean (Mucuna pruriens) and soybean tempe.

Introduction: Previous studies have shown that the velvet bean, an indigenous legume in Indonesia, possesses high protein content and bioactive compounds. However, the utilization of velvet beans in tempe production remains underexplored. Methods: This study aims to address this research gap by investigating the physicochemical properties and sensory profiles of tempe made from velvet beans, both individually and in combination with soybean. The study involved the production of tempe using germinated and non-germinated velvet bean, soybean, and a soy-velvet bean combination (61:39% ratio). Physicochemical analyses, including hardness, firmness, colour, antioxidant capacity, proximate, pH, and titratable acidity, were conducted. Hedonic rating and Check-All-That-Apply (CATA) tests were also performed to assess the sensory attributes of fresh and fried tempe. Results and discussion: Germination treatment of velvet bean resulted in tempe with reduced hardness, firmness, antioxidant capacity, and pH levels compared to non-germinated velvet bean tempe. However, velvet bean tempe exhibited a darker colour, higher antioxidant capacity, higher pH levels, and lower titratable acidity compared to soybean tempe and soy-velvet bean combination tempe. The protein content in velvet bean tempe was found to be below the required threshold of 15%. Hedonic rating tests revealed that fresh and fried velvet bean tempe received lower scores than other samples. CATA tests identified specific sensory attributes essential for fresh and fried tempe, including beany aroma, white colour, nutty aroma, golden brown colour, solid and crunchy texture, umami taste, and nutty aftertaste. These findings provide valuable insights into the potential applications of velvet beans in tempe production and emphasize the significance of considering germination as a factor affecting the quality and sensory attributes of tempe.