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

Introduction: Pre-exposure prophylaxis (PrEP) is effective at preventing HIV infection, but PrEP cost-effectiveness is sensitive to PrEP implementation and program costs. Preliminary studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and user support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Methods: Taking a guidelines-based approach for visits, labs and drugs assuming fidelity to the expanded 2018 Zambian PrEP guidelines, 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 the HIV counselling and testing service at primary healthcare centres). Program start-up, provider, and user 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 (in 2018 USD). Results: The annual cost per PrEP client varied greatly by program type, from $394 (AGYW) to $760 in an integrated program. Cost differences were driven largely by volume (i.e. the number of clients initiated/model/site) which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs, including staff and overheads, labs and monitoring, drugs and consumables ranged narrowly from $208-217/PrEP-user. Service delivery costs were a key component in the cost of PrEP, representing 36-65% of total costs. Reductions in service delivery costs per PrEP client are expected with further scale-up. Conclusions: 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 user support. Improved data on individual client resource usage (e.g. drugs, labs, visits) and outcomes (e.g. initiation, persistence) is required to get a better understanding of the true resource utilization, cost and expected outcomes and annual costs of different PrEP programs in Zambia.

Maritime Digital Twin architecture

Digital Twins (DTs) play an important role in current digitalization trends across industries. As maritime markets are particularly affected by recent global tendencies such as increasing delivery costs or political pressure for decarbonization, DT solutions could provide important support for shipbuilding and shipping companies to master recent and upcoming challenges. This paper provides a brief insight into the current state of the maritime industry and shows possible use-cases for DT Ship applications throughout the entire product lifecycle. To further advance the general understanding of DTs and their implementation, the concept of a Maritime Digital Twin Architecture (MDTA) is proposed to structure practical DT features.

Examining the Unit Costs of COVID-19 Vaccine Delivery in Kenya

Background: Vaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. Methods: We used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews (n=12) with stakeholders involved in the vaccine delivery and administration at a national level and in two counties were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with two doses, and the vaccine delivery costs per person vaccinated with two doses were estimated and reported in 2021 USD. Results: The financial costs of vaccine procurement per person vaccinated with two doses ranged from $2.89 to $13.09 in the 30% and 100% coverage levels respectively. The economic costs of vaccine procurement per person vaccinated with two doses was $17.34 across all strategies. With regard to unit vaccine delivery costs per person vaccinated with two doses, the financial costs ranged from $4.28 to $3.29 in the 30% and 100% coverage strategies: While the economic delivery costs were two to three times higher than the financial costs. The total procurement and delivery costs per person vaccinated with 2-doses ranged from $7.34 to $16.47 for the financial costs and $29.7 to $24.68 for the economic costs for the 30% and 100% coverage respectively. With the exception of procurement costs, the main cost driver of financial and economic delivery costs was supply chain costs (47-59%) and advocacy, communication and social mobilization (29-35%) respectively. Conclusion: This analysis presents cost estimates that can be used to inform local policy and may further inform parameters used in cost-effectiveness models. The results could potentially be adapted and adjusted to country-specific assumptions to enhance applicability in similar low-and middle-income settings.

Product Selling vs. Pay-Per-Use Service: A Strategic Analysis of Competing Business Models

We present a model that suggests possible explanations for the observed proliferation of “pay-per-use” (PPU) business models over the last two decades. Delivering “fractions” of a product as a service offers a cost advantage to customers with lower usage but requires extra delivery costs. Previous research focused on information goods (with negligible production costs) and predicted that PPU, when arising as a differentiation to selling in equilibrium, would fundamentally achieve lower profits than selling. We extend the theory by covering goods with any production cost in duopolistic competition. We show that PPU business models can be more profitable than selling (especially at midrange production costs), as long as their delivery costs are not too high, a requirement that is more easily fulfilled as new technologies reduce these costs. Moreover, if firms are imperfectly informed about their customers’ usage profiles, PPU’s effective pricing of customers’ varying usage offers an additional advantage over selling. This requires companies to employ accounting methods that do not inappropriately allocate production costs over stochastic usage levels. If PPU service provision suffers from queueing inefficiencies, this does not fundamentally change the relative profitability of the PPU and selling models, provided that PPU providers can attract sufficiently high demand to benefit from pooling economies. This paper was accepted by Charles Corbett, operations management.

Efficiency in PrEP Delivery: Estimating the Annual Costs of Oral PrEP in Zimbabwe

Although oral PrEP is highly effective at preventing HIV acquisition, optimizing continuation among beneficiaries is challenging in many settings. We estimated the costs of delivering oral PrEP to populations at risk of HIV in seven clinics in Zimbabwe. Full annual economic costs of oral PrEP initiations and continuation visits were estimated from the providers’ perspective for a six-clinic NGO network and one government SGBV clinic in Zimbabwe (January–December 2018). Disaggregating costs of full initiation and incremental follow-up visits enabled modeling of the impact of duration of continuation on the cost per person-year ($pPY) on PrEP. 4677 people initiated oral PrEP, averaging 2.7 follow-up visits per person. Average cost per person initiated was $238 ($183–$302 across the NGO clinics; $86 in the government facility). The full cost per initiation visit, including central and direct costs, was $178, and the incremental cost per follow-up visit, capturing only additional resources used directly in the follow up visits, was $22. The average duration of continuation was 3.0 months, generating an average $pPY of $943, ranging from $839 among adolescent girls and young women to $1219 in men. Oral PrEP delivery costs varied substantially by scale of initiations and by duration of continuation and type of clinic. Extending the average oral PrEP continuation from 2.7 to 5 visits (about 6 months) would greatly improve service efficiency, cutting the $pPY by more than half.

User logistics profiling for terminal distribution based on adaptive large adjacent search

With the volume growth of delivery business, terminal distribution plays a more and more important role in logistics as it faces consumers directly. User Profiling as an important tool to realize user-centric interaction design can provide more accurate information for terminal distribution. By user profiling, the design team can better understand and satisfy users and their demands for the product and service. This paper studies the problem of terminal delivery route planning considering user logistic profiles. It mainly generates user profiles from two aspects: consumers’ preference for self-pickup services and consumers’ complaint tendencies. Based on the results of user profiles, an Adaptive Large Adjacent Search algorithm is established to design the delivery route of terminal distribution and determine the appropriate delivery strategy to reduce delivery costs and improve customer satisfaction.

Perancangan Distribusi Produk Tepung Bumbu PT.SI Dengan Metode Distribution Requirement Planning

<div class="WordSection1"><p><strong>PT. SI is an FMCG (Fast Moving Consumer Goods) of seasoning and foods corporate in Indonesia. PT. SI’s products such as MNG (Mono Natrium Glutamate), Seasoning Flour (SF), a range of condiments, coconut milk, and instant seasoning. PT SI has SF product’s selling data from 2017 until 2020. However, that data yet to be used optimally. That data could be processed further for the organization’s advantage. For example, to knowledge the trend that’s happening, and, for predicting sales value with doing some forecasting and designing DRP. Based on the calculation of the forecasting, we’re obtained the best results using Double Exponential Smoothing by Brown, whereas Mean Absolute Percentage Error’s value is the smallest between the other methods. DRP’s methods make scheduling for the demand of products for determining times and the amounts that needed, and determining plans for arriving products to anticipates sales. With the scheduling, therefore, the distributions can go smoothly and meet the needs of every distribution center. For acknowledging the amounts of trucks that we use, the sums of PORelease is divided with the trucks’ capacities which are 18 tonnages for one delivery, therefore, the delivery costs that we got are multiplied by the transport’s cost for every destination. For distribution costs, company costs are as much as Rp. 20,831,275,897 whereas with DRP method acquired the value for Rp. 17,611,094,522 margins 15,45% from company cost.</strong></p><p><strong><em>Keywords – </em></strong><em>Distribution Requirement Planning, Forecasting, Distribution cost.</em></p></div>

Development and research of a model for optimizing the composition of a project-oriented forwarding company’ suppliers

The object of this research is the composition of the suppliers of a project-oriented transport and forwarding company. The work is aimed at determining the composition of the suppliers of a project-oriented transport and forwarding company, the purpose of which is to obtain a synergistic effect, which manifests itself in reducing the costs of performing individual operations of the transport process while meeting local requirements for each project. This study proposes an optimization model that allows to determine the composition of suppliers of a project-oriented organization in order to obtain the maximum systemic effect – a synergistic effect. The proposed approach is based on the creation of a virtual project management office, the work of which is based on the corresponding information system. The proposed model is a flexible tool that allows to quickly form the composition of suppliers of a project-oriented company. The model is developed for the service sector and, in particular, for the transport industry, where suppliers are not responsible for material objects, resources, but for services, the set of which forms the essence of the project. Thus, the product of the project and its parameters in such a situation are directly formed due to the specifics of suppliers and the parameters of their services. For the transport industry, this approach has not been used before and can serve as a theoretical basis for building a project-oriented management system in the transport sector. The synergistic effect taken as a basis in this model provides the greatest difference between the «declared» delivery costs and the «actual» ones, which are formed taking into account the amount of work for all projects. Since the freight forwarding company is the «holder» of the portfolio of all deliveries/projects, a certain part of the synergy effect can be used to reduce delivery costs for customers in order to increase competitiveness and attractiveness. Experimental studies have substantiated the reliability of the results of the developed model and confirmed its practical applicability. This model is quite universal and can be supplemented with restrictions that take into account the specifics of a project-oriented organization, its projects and requirements for suppliers.