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Background: HIV epidemic is one among the major public health problems in Sub-saharan countries including Tanzania. However, women bear a disproportionally higher share of the disease burden accounting for about 60% of all new infection. The gender disparity in HIV incidence is more marked at the age of 15-24, Adolescent girls and young women(AGYW) in 2016 had 44% higher incidence of HIV compared to their male counterpart. High vulnerability of AGYW to HIV is compounded by behavioural, biological and structural factors. This study analysed the cost-effectiveness of preventing HIV infection to AGYW using Oral Pre-exposure Prophylaxis delivered through youth friendly clinic in Tanzania.

Methods: A Markov model comprising PrEP use status states and HIV states basing on WHO clinic staging was used to calculate the cost-effectiveness of intervention. A model simulated a lifecycle of 3-months in 10 years’ time horizon of 575727 AGYW, we used payer’s perspective and both cost and health outcome were discounted at annual rate of 3%. One-way sensitivity analysis was used to evaluate the impact of change of input parameters on results and probabilistic analysis was used to assess the robustness of the results.

Results: Basing on threshold of 2632.53 USD (representing 3 times Tanzania GDP) rolling PrEP was not cost-effective as compared to status quo. However, in Ten years’ time rolling PrEP will avert the spending of 41 million USD which would otherwise be spent to manage HIV cases which can potentially be averted by PrEP.

Conclusion: There is no doubt PrEP rollout will require additional resource to be made available from already constrained health budget but given the cost saving advantage of PrEP and its ability to avert HIV infection there is strong rationale for it to be rolled out.