A Policy Analysis of Health System Costs and Financing Strategies for Integrating Oral HIV PrEP into Routine Sexual Health Services in Kenya, 2021–2026

This policy analysis examines the health system costs and financing strategies required for the sustainable integration of oral HIV pre-exposure prophylaxis (PrEP) into routine sexual health services in Kenya. Although PrEP is efficacious, its scale-up across Africa faces systemic financial constraints, with a research gap concerning viable, domestically-led financing models to transition from donor-dependent pilots. Employing a rigorous, desk-based methodology, this study systematically analysed Kenyan policy documents, programme reports, and economic evaluations (2021–2026) using a structured health systems framework. The findings detail substantial upfront costs for workforce training, commodity procurement, and monitoring systems, even within integrated service models. The analysis demonstrates that current over-reliance on volatile external funding directly threatens programme sustainability. It identifies and evidences specific blended financing strategies, including: increased earmarked allocation within the National AIDS Control Council budget; strategic purchasing mechanisms via the National Hospital Insurance Fund; and enhanced resource mapping and commitment from county governments. This study provides an original, evidence-based contribution to health financing policy. It offers Kenyan and regional policymakers a concrete, analysed set of co-financing options to secure the long-term viability of PrEP, thereby supporting the achievement of national HIV prevention targets and advancing health systems resilience.