Abstract
The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in "Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa." Program planners and policy makers should consider the significant contribution of supply chain and waste management to VMMC program costs as they determine future resource needs for VMMC programs.
Highlights
Experience with the voluntary medical male circumcision (VMMC) program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al in ‘‘Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa.’’ Program planners and policy makers should consider the significant contribution of supply chain and waste management to VMMC program costs as they determine future resource needs for VMMC programs
Based on evidence from randomized controlled clinical trials conducted in Africa indicating that voluntary medical male circumcision (VMMC) significantly reduces male participants’ risk of acquiring HIV infection, the global HIV prevention community has supported the scale-up of VMMC programs in 14 countries [1,2,3]
Evidence suggests that reaching a goal of 80% VMMC coverage in 5 y and sustaining it thereafter would avert more than 3.6 million adult HIV infections in the 15 y and benefit as many as 20.3 million adult HIV-negative men for HIV prevention purposes [4]
Summary
Based on evidence from randomized controlled clinical trials conducted in Africa indicating that voluntary medical male circumcision (VMMC) significantly reduces male participants’ risk of acquiring HIV infection, the global HIV prevention community has supported the scale-up of VMMC programs in 14 countries [1,2,3]. Evidence suggests that reaching a goal of 80% VMMC coverage in 5 y and sustaining it thereafter would avert more than 3.6 million adult HIV infections in the 15 y and benefit as many as 20.3 million adult HIV-negative men for HIV prevention purposes [4]. Reaching this population with comprehensive VMMC services will have substantial implications for the coordination of human resources [5], commodities, and infrastructure. Mathematical models suggest that, if 80% VMMC coverage is reached by 2015 (which will entail performing 20.33 million circumcisions between 2011 and 2015) and sustained thereafter, VMMC programs in these priority countries will avert more than 4 million HIV infections among adults between 2009 and 2025
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