Marseille 2007
| Abstract #634 - Costing Adult Male Circumcision in High HIV Prevalence Countries | ||||
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Session: 49.2: Late Breakers (Parallel) on Wednesday @ 08.30-10.30 in HC Chaired by Bruno Spire, Kate Hankins Authors: Presenting Author: Dr John Vincent Fieno - RTI International, United States |
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| Aim: The dramatic evidence that male circumcision has a substantial effect in preventing HIV-infection might be the most important medical finding in the course of the AIDS epidemic since the introduction of high active anti-retroviral therapy. The transition from clinical trails to implementation of a general adult male circumcision (AMC) program is beginning, and this paper tries to examine the cost of a rapid scale-up of an AMC program in Mozambique, a country with a generalized epidemic and low rate of male circumcision. | ||||
| Method / Issue: The paper will examine the cost of a rapid scale-up of AMC for different target outcomes (number of men circumcised over a given period of time). The paper will estimate a cost-function for AMC in Mozambique given its material and labor costs. It also tries to address problems in scale-up beyond fiscal resources; in particular, how an AMC program would affect human resources in health (HRH) and how it would be incorporated into other prevention strategies are crucial questions to the efficacy of AMC. One issue that has been ignored in the excitement over AMC is that all uncircumcised men should receive voluntary counseling and testing (VCT) before any surgery. | ||||
| Results / Comments: Three major findings: 1) While fiscal sustainability is less salient given that AMC is a one-time medical intervention, a rapid scale-up of AMC poses a substantial fiscal burden for Mozambique without foreign aid or mechanisms for cost recovery. 2) Even the most modest of AMC programs would place great stress on HRH, especially if VCT were required prior to surgery. 3) Task-shifting would be essential; Mozambique would need to train thousands of counselors for VCT and hundreds of surgical technicians for AMC because physicians and nurses are scarce. | ||||
| Discussion: The implementation of a general AMC program faces significant fiscal and HRH barriers, but the spillover effects during the implementation phase might be large too. As uncircumcised men might have to wait for months for their surgeries, their sexual behavior might change in the interim. In the time between VCT and their surgery, uncircumcised men might increase their condom use or have fewer sexual partners. On the other hand, if uncircumcised men are forced to wait for relatively long periods due to bottlenecks in the AMC program, they might choose to have the surgery performed sooner in the private sector, which might be nearly impossible to regulate. Finally, if VCT is coupled with AMC, the number of men that would be aware of their HIV-status would skyrocket, which might change everything from micro-level (individual sexual behavior) to the macro-level (planning for HAART). | ||||
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