Trends in the Marginal Cost of Male Circumcision in Rural Rakai Uganda

Abstract

Male circumcision (MC) is an effective intervention to reduce HIV acquisition in men in Africa. We conducted a cost analysis using longitudinal data on expenditures on services and community mobilization to estimate the marginal cost of MC over time and understand cost drivers during scale up. We used a time-series with monthly records from 2008 to 2013, for a total of 72 monthly observations, from the Rakai MC program in Uganda. GLM models were used to estimate the marginal cost of a MC procedure. The marginal cost per MC in a mobile camp was $23 (p<0.01) and in static facilities was $35 (p<0.1). Major cost drivers included supplies in mobile camps with increasing number of surgeries, savings due to task shifting from physicians to clinical officers and increased efficiency as personnel became more experienced. As scale up continues, marginal costs may increase due to mobilization needed for less motivated late adopters, but improved efficiency could contain costs.

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review

“…Eleven studies presented cost data [14,25,[36][37][38][39][40][41][42][43][44], three of which were related to articles included in the main effectiveness review. Studies were published between 2012 and 2018 and took place in Kenya [38,41], South Africa [39,42,43], Tanzania [44], Uganda [36,37,40], and Zimbabwe [14,25]. Descriptions of included cost studies and their outcomes are presented in Table 5.…”

“…Descriptions of included cost studies and their outcomes are presented in Table 5. Seven of the included studies assessed community-based interventions [14,36,[40][41][42][43][44], two assessed school-based interventions [25,39], and two assessed facility-based interventions [37,38]. Generally, cost studies showed that service delivery interventions may create economies of scale and efficiencies when implemented widely.…”

“…Though activities to enhance uptake increase total costs, linkage to VMMC services that use task-shifting/sharing providers, pre-established facilities (both fixed site VMMC clinics and other clinics temporarily repurposed for VMMC services), and integrated HIV, sexual, and reproductive health services may save costs. Five studies assessing community-based interventions compared costs between various service delivery modalities, including mobile vs fixed, outreach vs fixed, and horizontal vs diagonal [36,[40][41][42][43]. These studies had mixed results.…”

“…These studies had mixed results. One study comparing mobile and fixed service delivery in Uganda found that mobile services had a marginal cost per VMMC of US$23 (range: US$17 to US$27) compared with US$35 (range: US$35 to US$40) for fixed-site service delivery [36]. Another study in Uganda found that mobile services were in fact more expensive than fixed-site services (US$61-72 per mobile VMMC compared with US$34 per fixed VMMC) [40].…”

The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis

“…[ 9 ] Task shifting of VMMC has been successful in other African countries[ 10 – 12 ] and has reduced costs. [ 13 , 14 ] In particular, CAs should contribute to the health workforce by diagnosing and managing common conditions and minor surgical procedures such as VMMCs.…”