title: Costs and impacts of scaling up voluntary medical male circumcision in Tanzania.
abstract: BACKGROUND
  Given the proven effectiveness of voluntary medical male circumcision (VMMC) in preventing the spread of HIV, Tanzania is scaling up VMMC as an HIV prevention strategy. This study will inform policymakers about the potential costs and benefits of scaling up VMMC services in Tanzania.
  
  
  METHODS
  The analysis first assessed the unit costs of delivering VMMC at the facility level in three regions-Iringa, Kagera, and Mbeya-via three currently used VMMC service delivery models (routine, campaign, and mobile/island outreach). Subsequently, using these unit cost data estimates, the study used the Decision Makers' Program Planning Tool (DMPPT) to estimate the costs and impact of a scaled-up VMMC program.
  
  
  RESULTS
  Increasing VMMC could substantially reduce HIV infection. Scaling up adult VMMC to reach 87.9% coverage by 2015 would avert nearly 23,000 new adult HIV infections through 2015 and an additional 167,500 from 2016 through 2025-at an additional cost of US$253.7 million through 2015 and US$302.3 million from 2016 through 2025. Average cost per HIV infection averted would be US$11,300 during 2010-2015 and US$3,200 during 2010-2025. Scaling up VMMC in Tanzania will yield significant net benefits (benefits of treatment costs averted minus the cost of performing circumcisions) in the long run-around US$4,200 in net benefits for each infection averted.
  
  
  CONCLUSIONS
  VMMC could have an immediate impact on HIV transmission, but the full impact on prevalence and deaths will only be apparent in the longer term because VMMC averts infections some years into the future among people who have been circumcised. Given the health and economic benefits of investing in VMMC, the scale-up of services should continue to be a central component of the national HIV prevention strategy in Tanzania.
authors.affiliation: HPI Costing Task Order, Washington, District of Columbia, United States of America; Futures Group, Washington, District of Columbia, United States of America.
authors.forename: Veena
authors.initials: V
authors.lastname: Menon
authors.affiliation: Maternal and Child Health Integrated Program Jhpiego, Baltimore, Maryland, United States of America.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gold
authors.affiliation: HPI Costing Task Order, Washington, District of Columbia, United States of America; Futures Group, Washington, District of Columbia, United States of America; United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Ramona
authors.initials: R
authors.lastname: Godbole
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.affiliation: Maternal and Child Health Integrated Program Jhpiego, Dar es Salaam, Tanzania.
authors.forename: Hally
authors.initials: H
authors.lastname: Mahler
authors.affiliation: HPI Costing Task Order, Washington, District of Columbia, United States of America; Futures Institute, Glastonbury, Connecticut, United States of America.
authors.forename: Steven
authors.initials: S
authors.lastname: Forsythe
authors.affiliation: Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Mariam
authors.initials: M
authors.lastname: Ally
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
mesh_terms: D002944:Circumcision, Male / Q000191:economics*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D011314:Preventive Health Services / Q000191:economics; D013636:Tanzania