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How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?

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  • Bruce Larson
  • Allan Tindikahwa
  • George Mwidu
  • Hannah Kibuuka
  • Fred Magala

Abstract

Background: The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015). Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites). The difference between such costs is the cost of improving access to VMMC. Methods: A micro-costing approach was used to estimate costs from the service provider’s perspective of a circumcision. Supply chain and higher-level program support costs are not included. Results: The average cost (US$2012) of resources used per circumcision was $61 in the mobile program ($72 for more remote locations) compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time. Conclusion: The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment.

Suggested Citation

  • Bruce Larson & Allan Tindikahwa & George Mwidu & Hannah Kibuuka & Fred Magala, 2015. "How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-11, March.
    • Handle: RePEc:plo:pone00:0119484
    DOI: 10.1371/journal.pone.0119484
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    References listed on IDEAS

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    1. Bertran Auvert & Elliot Marseille & Eline L Korenromp & James Lloyd-Smith & Remi Sitta & Dirk Taljaard & Carel Pretorius & Brian Williams & James G Kahn, 2008. "Estimating the Resources Needed and Savings Anticipated from Roll-Out of Adult Male Circumcision in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 3(8), pages 1-8, August.
    2. Emily Evens & Michele Lanham & Catherine Hart & Mores Loolpapit & Isaac Oguma & Walter Obiero, 2014. "Identifying and Addressing Barriers to Uptake of Voluntary Medical Male Circumcision in Nyanza, Kenya among Men 18–35: A Qualitative Study," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-7, June.
    3. James G Kahn & Elliot Marseille & Bertran Auvert, 2006. "Cost-Effectiveness of Male Circumcision for HIV Prevention in a South African Setting," PLOS Medicine, Public Library of Science, vol. 3(12), pages 1-10, December.
    4. Dianna Edgil & Petra Stankard & Steven Forsythe & Dino Rech & Kristin Chrouser & Tigistu Adamu & Sameer Sakallah & Anne Goldzier Thomas & Jennifer Albertini & David Stanton & Kim Eva Dickson & Emmanue, 2011. "Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services," PLOS Medicine, Public Library of Science, vol. 8(11), pages 1-10, November.
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