Abstract
BackgroundFourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program.Methods and FindingsWe evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service (“routine surgery site”) and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study (“mixed study site”). We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased.ConclusionsVMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established.
Highlights
In 2005–2007, three randomized controlled clinical trials demonstrated that voluntary medical male circumcision (VMMC) reduced male acquisition of HIV through heterosexual intercourse by approximately 60% [1,2,3]
Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost
Implementation models Three implementation models were evaluated (Figure 1): a routine surgery site based on the configuration of the Bulawayo VMMC Centre, a mixed study site based on the configuration of the Harare PrePex Field Study Site, and a hypothetical mixed site with a configuration comparable to that of the routine surgery site
Summary
In 2005–2007, three randomized controlled clinical trials demonstrated that voluntary medical male circumcision (VMMC) reduced male acquisition of HIV through heterosexual intercourse by approximately 60% [1,2,3]. The availability of devices might offer an alternative mode of VMMC for men who have fears related to conventional surgery. Fourteen African countries are scaling up voluntary medical male circumcision (VMMC) for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program
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