Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa

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dc.contributor.authorAuvert, Bertran
dc.contributor.authorMarseille, Elliot
dc.contributor.authorKorenromp, Eline L.
dc.contributor.authorLloyd-Smith, James
dc.contributor.authorSitta, Remi
dc.contributor.authorTaljaard, Dirk
dc.contributor.authorPretorius, Carel
dc.contributor.authorWilliams, Brian
dc.contributor.authorKahn, James G.
dc.date.accessioned2011-05-15T16:00:16Z
dc.date.available2011-05-15T16:00:16Z
dc.date.issued2008-08
dc.descriptionThe original publication is available at http:/www.plosone.orgen_ZA
dc.description.abstractBackground: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. Methods: We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. Results: In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95% PI: 726 to 1 245).The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). Conclusion: A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability. Copyright: © 2008 Auvert et al.en_ZA
dc.description.versionPublishers' Version
dc.format.extent8 p. : ill.
dc.identifier.citationAuvert, B. et al. 2008. Estimating the Resources Needed and Savings Anticipated from Roll-Out of Adult Male Circumcision in Sub-Saharan Africa. PLoS ONE, 3(8): e2679, doi:10.1371/journal.pone.0002679.en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0002679
dc.identifier.urihttp://hdl.handle.net/10019.1/11615
dc.language.isoen_ZA
dc.publisherPublic Library of Science (PLOS)
dc.rights.holderAuthors retain copyright
dc.subject.geogAfrica, Sub-Saharan -- Economic conditionsen_ZA
dc.subject.lcshHIV infections -- Prevention -- Cost effectiveness -- Africa, Sub-Saharanen_ZA
dc.subject.lcshCircumcision -- Cost effectiveness -- Africa, Sub-Saharanen_ZA
dc.subject.lcshFeasibility studiesen_ZA
dc.subject.lcshCircumcision -- Economic aspects -- Africa, Sub-Saharanen_ZA
dc.titleEstimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africaen_ZA
dc.typeArticleen_ZA
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