The Cost of Voluntary Medical Male Circumcision in South Africa.
The Cost of Voluntary Medical Male Circumcision in South Africa.
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DOI：
10.1371/journal.pone.0160207
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Forsythe S
中科院分区：
文献类型：
--
作者：
Tchuenche M;Palmer E;Haté V;Thambinayagam A;Loykissoonlal D;Njeuhmeli E;Forsythe S
鉴于有令人信服的证据表明自愿医疗男性包皮环切术（VMMC）与男性通过异性性行为感染艾滋病毒的减少有关，南非于2010年开始扩大自愿医疗男性环切术。为了预测2010年至2016年间完成430万例包皮环切手术所需的资源，我们(1)估算了提供VMMC的单位成本；(2)评估了8个省份和VMMC服务交付模式的成本驱动因素和成本差异；(3)评估了动员和激励男性和男孩获得志愿医疗服务的相关成本。从33个政府和pepfar支持的（美国总统艾滋病紧急救援计划）城市、农村和城郊的VMMC设施系统地收集和分析了成本数据。2014年每例包皮环切手术的费用为132美元（1431兰特）：公立医院的费用（158美元[1710兰特]）高于卫生中心和诊所的费用（121美元[1309兰特]）。固定的包皮环切地点和提供外展服务的固定地点之间的费用没有实质性差异。通过将工作从医生转移到专业护士，直接人工成本可降低17%；这本来可以在2015年节省多达1500万美元（1.632亿兰特），当时的目标是进行160万例包皮环切手术。2014年，南非用于医疗男性包皮环切需求的支出约为1 420万美元（1.54亿兰特），主要用于人员，包括社区动员人员（36%），以及小型和大众媒体宣传（35%）。计算VMMC需求创建的单位成本是令人生畏的，因为分母上的数据（获得需求创建消息的人数或由于需求创建而寻求VMMC的人数）是不可用的。由于没有关于需求创造的“剂量-反应”数据（X美元的需求创造将导致VMMC客户额外增加Z%），因此需要进行研究以确定需求创造资源的适当数量和分配。
Given compelling evidence associating voluntary medical male circumcision (VMMC) with men’s reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider’s perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014—primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no “dose-response” data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources.
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