title: Evaluating Opportunities for Achieving Cost Efficiencies Through the Introduction of PrePex Device Male Circumcision in Adult VMMC Programs in Zambia and Zimbabwe.
abstract: Results from recent costing studies have put into question potential Voluntary Medical Male Circumcision (VMMC) cost savings with the introduction of the PrePex device.
  
  
  
  We evaluated the cost drivers and the overall unit cost of VMMC for a variety of service delivery models providing either surgical VMMC or both PrePex and surgery using current program data in Zimbabwe and Zambia. In Zimbabwe, 3 hypothetical PrePex only models were also included. For all models, clients aged 18 years and older were assumed to be medically eligible for PrePex and uptake was based on current program data from sites providing both methods. Direct costs included costs for consumables, including surgical VMMC kits for the forceps-guided method, device (US $12), human resources, demand creation, supply chain, waste management, training, and transport.
  
  
  
  Results for both countries suggest limited potential for PrePex to generate cost savings when adding the device to current surgical service delivery models. However, results for the hypothetical rural Integrated PrePex model in Zimbabwe suggest the potential for material unit cost savings (US $35 per VMMC vs. US $65-69 for existing surgical models).
  
  
  
  This analysis illustrates that models designed to leverage PrePex's advantages, namely the potential for integrating services in rural clinics and less stringent infrastructure requirements, may present opportunities for improved cost efficiency and service integration. Countries seeking to scale up VMMC in rural settings might consider integrating PrePex only MC services at the primary health care level to reduce costs while also increasing VMMC access and coverage.
authors.affiliation: *Clinton Health Access Initiative, Pretoria, South Africa; †Society for Family Health (Population Services International), Zambia; ‡Population Services International; §Clinton Health Access Initiative, Lilongwe, Malawi; ‖Ministry of Health and Child Care, Harare, Lusaka, Zimbabwe; ¶Ministry of Community Development Mother and Child Health, Lusaka, Zambia; #Clinton Health Access Initiative, Lusaka, Zambia; **Clinton Health Access Initiative, Harare, Zimbabwe; and ††Clinton Health Access Initiative, New York, NY.
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Vandament
authors.forename: Naminga
authors.initials: N
authors.lastname: Chintu
authors.forename: Nanako
authors.initials: N
authors.lastname: Yano
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.forename: Bushimbwa
authors.initials: B
authors.lastname: Tambatamba
authors.forename: Gertrude
authors.initials: G
authors.lastname: Ncube
authors.forename: Sinokuthemba
authors.initials: S
authors.lastname: Xaba
authors.forename: Felton
authors.initials: F
authors.lastname: Mpasela
authors.forename: Edward
authors.initials: E
authors.lastname: Muguza
authors.forename: Tichakunda
authors.initials: T
authors.lastname: Mangono
authors.forename: Ngonidzashe
authors.initials: N
authors.lastname: Madidi
authors.forename: Alick
authors.initials: A
authors.lastname: Samona
authors.forename: Elva
authors.initials: E
authors.lastname: Tagar
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000191:economics* / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D015024:Zambia; D015030:Zimbabwe