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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?

Publication year: 
Author (s): 
Larson, Bruce [et al].
Publication details: 
Uganda, PLOS, 2015
Publication in: 
PLOS ONE | DOI:10.1371/journal.pone.0119484 March 16, 2015

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.

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.

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 addition 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.