title: The Cost of Voluntary Medical Male Circumcision in South Africa.
abstract: Given compelling evidence associating voluntary medical male circumcision (VMMC) with men's reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider's perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014-primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no "dose-response" data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources.
authors: Health Policy Project, Project SOAR (Supporting Operational AIDS Research), Avenir Health, Washington, District of Columbia, United States of America.
authors: Michel
authors: M
authors: Tchuenche
authors: Health Policy Project, Palladium Consultant, Johannesburg, South Africa.
authors: Eurica
authors: E
authors: Palmer
authors: George Washington University, Washington, District of Columbia, United States of America.
authors: Vibhuti
authors: V
authors: Haté
authors: USAID, Pretoria, South Africa.
authors: Ananthy
authors: A
authors: Thambinayagam
authors: National Department of Health, Pretoria, South Africa.
authors: Dayanund
authors: D
authors: Loykissoonlal
authors: USAID, Washington, District of Columbia, United States of America.
authors: Emmanuel
authors: http://orcid.org/0000-0001-5370-4827
authors: E
authors: Njeuhmeli
authors: Health Policy Project, Project SOAR (Supporting Operational AIDS Research), Avenir Health, Washington, District of Columbia, United States of America.
authors: Steven
authors: S
authors: Forsythe
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002944:Circumcision, Male / Q000191:economics*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control; D006268:Health Facilities / Q000191:economics; D006801:Humans; D008297:Male; D013019:South Africa; D014507:Urbanization
chemical_list: D044966:Anti-Retroviral Agents