title: Trends in the Marginal Cost of Male Circumcision in Rural Rakai Uganda.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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. Generalized linear models were used to estimate the marginal cost of an MC procedure.
  
  
  RESULTS
  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 numbers of surgeries, savings due to task shifting from physicians to clinical officers, and increased efficiency as personnel became more experienced.
  
  
  CONCLUSIONS
  As scale-up continues, marginal costs may increase because of mobilization needed for less motivated late adopters, but improved efficiency could contain costs.
authors: *Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; †Rakai Health Sciences Program, Kalisizo, Uganda; ‡School of Medicine, Johns Hopkins University, Baltimore, MD; and §Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors: Yira N
authors: YN
authors: Alfonso
authors: David
authors: D
authors: Bishai
authors: Agnes
authors: A
authors: Nantongo
authors: Rebecca
authors: R
authors: Kakembo
authors: Sarah
authors: S
authors: Kobusinge
authors: Seema
authors: S
authors: Kacker
authors: Godfrey
authors: G
authors: Kigozi
authors: Ronald
authors: R
authors: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000368:Aged; D002944:Circumcision, Male / Q000191:economics*; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014454:Uganda; D055815:Young Adult