Health Policy Project

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New Research in Eastern and Southern Africa Shows High-Quality Voluntary Medical Male Circumcision Can Be Implemented Effectively and At Scale

Health Policy Project

Washington, DC—A new collection of 13 research studies, featured in PLOS ONE and PLOS Medicine and funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Bill & Melinda Gates Foundation, provides evidence from five African countries that safe, high quality voluntary medical male circumcision (VMMC) services performed by trained healthcare professionals in low-resource settings can be implemented and sustained at scale and have the potential to significantly prevent new HIV infections in adolescent and adult men.

The new PLOS collection, “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-Up,” includes three costing studies conducted by PEPFAR through the USAID-funded Health Policy Project. Estimating the costs and benefits of voluntary medical male circumcision services is crucial to the success of scale-up.

Key findings from the new costing studies

  • The benefits of VMMC far outweigh the costs. Menon, et al. found that in Tanzania, scaling up VMMC to reach target levels over a five-year period and then maintaining coverage through 2025 could prevent 190,500 HIV infections and result in savings of over US$800 million.
  • An analysis by Bollinger, et al. showed that there is significant room for exploiting economies of scale in the delivery of VMMC as the volume of circumcisions expand. VMMC remains in the scale-up phase, with personnel and consumables the most significant factors affecting the cost of VMMC. In addition to benefiting from economies of scale as service delivery scales up, there are other key opportunities to increase efficiency through task shifting/sharing.
  • In another study in Zimbabwe, Njeuhmeli et al. found that integrating device-based circumcisions into existing VMMC programs did not result in substantial cost savings.

Implications for the future

As the major cost drivers of VMMC services are personnel and consumables, strategies to increase efficiency and reduce costs include task shifting and/or sharing and aligning availability of services with demand. Integrating VMMC devices/procedures into conventional VMMC programs does not necessarily result in substantial cost savings. Findings from three new studies by PEPFAR through the Health Policy Project will be of interest to decision-makers determining the allocation of HIV prevention resources.

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Bollinger L , Adesina A, Forsythe S, Godbole R, Reuben E, et al. (2014) Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from sub-Saharan Africa. PLoS ONE 9(4): e84701. doi: 10.1371/journal.pone.0084701

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Menon V, Gold E, Godbole R, Castor D, Mahler H, et al. (2014) Costs and Impacts of Scaling up Voluntary Medical Male Circumcision in Tanzania. PLoS ONE 9(4): e83925. doi: 10.1371/journal.pone.0083925

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Njeuhmeli, E, Kripke K, Hatzold K, Reed J, Edgil D, et al. (2014) Cost Analysis of Integrating The PrePex Medical Device Into a Voluntary Medical Male Circumcision Program in Zimbabwe. PLoS ONE 9(4): e82533. doi: 10.1371/journal.pone.0082533

For more information, see USAID’s factsheets on the PLoS collection at www.ploscollections.org/VMMC2014.

 
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The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA). The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

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