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

Mangenah, C; Mavhu, W; Hatzold, K; Biddle, AK; Ncube, G; Mugurungi, O; Ticklay, I; ... Thirumurthy, H; + view all (2016) Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe. Global Health: Science and Practice , 4 (Suppl 1) S68-S75. 10.9745/GHSP-D-15-00201. Green open access

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Abstract

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.

Type: Article
Title: Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.9745/GHSP-D-15-00201
Publisher version: http://dx.doi.org/10.9745/GHSP-D-15-00201
Language: English
Additional information: Copyright © Mangenah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 3.0) (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-15-00201.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/1505879
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