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Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

BACKGROUND: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We...

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Autores principales: Mangenah, Collin, Mavhu, Webster, Hatzold, Karin, Biddle, Andrea K, Ncube, Getrude, Mugurungi, Owen, Ticklay, Ismail, Cowan, Frances M, Thirumurthy, Harsha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Global Health: Science and Practice 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944581/
https://www.ncbi.nlm.nih.gov/pubmed/27413085
http://dx.doi.org/10.9745/GHSP-D-15-00201
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author Mangenah, Collin
Mavhu, Webster
Hatzold, Karin
Biddle, Andrea K
Ncube, Getrude
Mugurungi, Owen
Ticklay, Ismail
Cowan, Frances M
Thirumurthy, Harsha
author_facet Mangenah, Collin
Mavhu, Webster
Hatzold, Karin
Biddle, Andrea K
Ncube, Getrude
Mugurungi, Owen
Ticklay, Ismail
Cowan, Frances M
Thirumurthy, Harsha
author_sort Mangenah, Collin
collection PubMed
description BACKGROUND: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. METHODS: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. RESULTS: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. CONCLUSIONS: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born.
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spelling pubmed-49445812016-07-18 Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe Mangenah, Collin Mavhu, Webster Hatzold, Karin Biddle, Andrea K Ncube, Getrude Mugurungi, Owen Ticklay, Ismail Cowan, Frances M Thirumurthy, Harsha Glob Health Sci Pract Original Article BACKGROUND: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. METHODS: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. RESULTS: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. CONCLUSIONS: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born. Global Health: Science and Practice 2016-07-02 /pmc/articles/PMC4944581/ /pubmed/27413085 http://dx.doi.org/10.9745/GHSP-D-15-00201 Text en © Mangenah et al. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-15-00201.
spellingShingle Original Article
Mangenah, Collin
Mavhu, Webster
Hatzold, Karin
Biddle, Andrea K
Ncube, Getrude
Mugurungi, Owen
Ticklay, Ismail
Cowan, Frances M
Thirumurthy, Harsha
Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
title Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
title_full Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
title_fullStr Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
title_full_unstemmed Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
title_short Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
title_sort comparative cost of early infant male circumcision by nurse-midwives and doctors in zimbabwe
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944581/
https://www.ncbi.nlm.nih.gov/pubmed/27413085
http://dx.doi.org/10.9745/GHSP-D-15-00201
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