title: Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services.
abstract: BACKGROUND
  The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs.
  
  
  RESULTS
  This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland.
  
  
  CONCLUSIONS
  Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in "Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa." Program planners and policy makers should consider the significant contribution of supply chain and waste management to VMMC program costs as they determine future resource needs for VMMC programs.
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, USA. dedgil@usaid.gov
authors.forename: Dianna
authors.initials: D
authors.lastname: Edgil
authors.forename: Petra
authors.initials: P
authors.lastname: Stankard
authors.forename: Steven
authors.initials: S
authors.lastname: Forsythe
authors.forename: Dino
authors.initials: D
authors.lastname: Rech
authors.forename: Kristin
authors.initials: K
authors.lastname: Chrouser
authors.forename: Tigistu
authors.initials: T
authors.lastname: Adamu
authors.forename: Sameer
authors.initials: S
authors.lastname: Sakallah
authors.forename: Anne Goldzier
authors.initials: AG
authors.lastname: Thomas
authors.forename: Jennifer
authors.initials: J
authors.lastname: Albertini
authors.forename: David
authors.initials: D
authors.lastname: Stanton
authors.forename: Kim Eva
authors.initials: KE
authors.lastname: Dickson
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
mesh_terms: D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000353:Africa, Southern / Q000453:epidemiology; D002944:Circumcision, Male / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D037001:Directive Counseling / Q000191:economics; D004389:Durable Medical Equipment / Q000191:economics; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D008297:Male; D017744:Medical Waste Disposal / Q000191:economics* / Q000592:standards; D011314:Preventive Health Services / Q000191:economics* / Q000458:organization & administration; D012749:Sexually Transmitted Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D017744:Medical Waste Disposal