IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0195691.html
   My bibliography  Save this article

The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda

Author

Listed:
  • Edward I Broughton
  • Esther Karamagi
  • Angella Kigonya
  • Anna Lawino
  • Lani Marquez
  • Sarah Smith Lunsford
  • Albert Twinomugisha

Abstract

Background: Uganda is working to increase voluntary medical male circumcision (VMMC) to prevent HIV infection. To support VMMC quality improvement, this study compared three methods of disseminating information to facilities on how to improve VMMC quality: M—providing a written manual; MH—providing the manual plus a handover meeting in which clinicians shared advice on implementing key changes and participated in group discussion; and MHC—manual, handover meeting, and three site visits to the facility in which a coach provided individualized guidance and mentoring on improvement. We determined the different effects these had on compliance with indicators of quality of care. Methods: This controlled pre-post intervention study randomized health facility groups to receive M, MH, or MHC. Observations of VMMCs performance determined compliance with quality indicators. Intervention costs per patient receiving VMMC were used in a decision-tree cost-effectiveness model to calculate the incremental cost per additional patient treated to compliance with indicators of informed consent, history taking, anesthesia administration, and post-operative instructions. Results: The most intensive method (MHC) cost $28.83 per patient and produced the biggest gains in history taking (35% improvement), anesthesia administration (20% improvement), and post-operative instructions (37% improvement). The least intensive method (M; $1.13 per patient) was most efficient because it produced small gains for a very low cost. The handover meeting (MH) was the most expensive among the three interventions but did not have a corresponding positive effect on quality. Conclusion: Health workers in facilities that received the VMMC improvement manual and participated in the handover meeting and coaching visits showed more improvement in VMMC quality indicators than those in the other two intervention groups. Providing the manual alone cost the least but was also the least effective in achieving improvements. The MHC intervention is recommended for broader implementation to improve VMMC quality in Uganda.

Suggested Citation

  • Edward I Broughton & Esther Karamagi & Angella Kigonya & Anna Lawino & Lani Marquez & Sarah Smith Lunsford & Albert Twinomugisha, 2018. "The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-11, April.
    • Handle: RePEc:plo:pone00:0195691
    DOI: 10.1371/journal.pone.0195691
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195691
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0195691&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0195691?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Dickens S Omondi Aduda & Collins Ouma & Rosebella Onyango & Mathews Onyango & Jane Bertrand, 2014. "Systematic Monitoring of Male Circumcision Scale-Up in Nyanza, Kenya: Exploratory Factor Analysis of Service Quality Instrument and Performance Ranking," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-7, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dickens S Omondi Aduda & Collins Ouma & Rosebella Onyango & Mathews Onyango & Jane Bertrand, 2015. "Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-17, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0195691. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.