Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less

Torres-Rueda, Sergio; Wambura, Mwita; Weiss, Helen A.; Plotkin, Marya; Kripke, Katharine; Chilongani, Joseph; Mahler, Hally; Kuringe, Evodius; Makokha, Maende; Hellar, Augustino; Schütte, Carl; Kazaura, Kokuhumbya; Simbeye, Daimon; Mshana, Gerry; Larke, Natasha; Lija, Gissenge; Changalucha, John; Vassall, Anna; Hayes, Richard; Grund, Jonathan M; Terris‐Prestholt, Fern

doi:10.1097/qai.0000000000001682

Cited by 12 publications

(17 citation statements)

References 39 publications

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“…Any discrepancies were resolved at the site using the source data. Costing data for the intervention were collected and are reported elsewhere [26]. …”

Section: Methodsmentioning

confidence: 99%

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

Wambura

Mahler

Grund

et al. 2017

Aids

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Objective:We evaluated a demand-creation intervention to increase voluntary medical male circumcision (VMMC) uptake among men aged 20–34 years in Tanzania, to maximise short-term impact on HIV incidence.Methods:A cluster randomized controlled trial stratified by region was conducted in 20 outreach sites in Njombe and Tabora regions. The sites were randomized 1 : 1 to receive either a demand-creation intervention package in addition to standard VMMC outreach, or standard VMMC outreach alone. The intervention package included enhanced public address messages, peer promotion by recently circumcised men, facility setup to increase privacy, and engagement of female partners in demand creation. The primary outcome was the proportion of VMMC clients aged 20–34 years.Findings:Overall, 6251 and 3968 VMMC clients were enrolled in intervention and control clusters, respectively. The proportion of clients aged 20–34 years was slightly greater in the intervention than control arm [17.7 vs. 13.0%; prevalence ratio = 1.36; 95% confidence intervals (CI):0.9–2.0]. In Njombe region, the proportion of clients aged 20–34 years was similar between arms but a significant two-fold difference was seen in Tabora region (P value for effect modification = 0.006). The mean number of men aged 20–34 years (mean difference per cluster = 97; 95% CI:40–154), and of all ages (mean difference per cluster = 227, 95% CI:33–420) were greater in the intervention than control arm.Conclusion:The intervention was associated with a significant increase in the proportion of clients aged 20–34 years in Tabora but not in Njombe. The intervention may be sensitive to regional factors in VMMC programme scale-up, including saturation.

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“…Any discrepancies were resolved at the site using the source data. Costing data for the intervention were collected and are reported elsewhere [26]. …”

Section: Methodsmentioning

confidence: 99%

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

Wambura

Mahler

Grund

et al. 2017

Aids

Self Cite

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“…Eleven studies presented cost data [14,25,[36][37][38][39][40][41][42][43][44], three of which were related to articles included in the main effectiveness review. Studies were published between 2012 and 2018 and took place in Kenya [38,41], South Africa [39,42,43], Tanzania [44], Uganda [36,37,40], and Zimbabwe [14,25]. Descriptions of included cost studies and their outcomes are presented in Table 5.…”

Section: Costsmentioning

confidence: 99%

“…Descriptions of included cost studies and their outcomes are presented in Table 5. Seven of the included studies assessed community-based interventions [14,36,[40][41][42][43][44], two assessed school-based interventions [25,39], and two assessed facility-based interventions [37,38]. Generally, cost studies showed that service delivery interventions may create economies of scale and efficiencies when implemented widely.…”

Section: Costsmentioning

confidence: 99%

“…Dates of publication ranged from 2011 to 2014. Studies were from Kenya [45][46][47], South Africa [44], eSwatinti [46], Tanzania [45,46], and Zimbabwe [45]; two studies aggregated data from multiple countries [45,46]. These studies examined several intervention strategies, all community-based approaches to VMMC scale-up including Service delivery interventions for VMMC uptake campaigns and task-shifting/sharing.…”

Section: Feasibilitymentioning

confidence: 99%

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Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review

et al. 2020

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BackgroundVoluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify. showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies. ConclusionsInnovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation.Service delivery interventions for VMMC uptake PLOS ONE | https://doi.org/10.

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“…The strategies Kenya has used to achieve the national target of circumcising 80% of the country’s adult males [ 27 ] have routinely overlooked SCY who do not access health services through traditional channels [ 27 , 28 ]. Programs which employ innovative and locally-tailored approaches to youth and hard-to-reach populations have shown higher circumcision rates, more efficient resource utilization and increased cost-savings [ 29 – 32 ].…”

Section: Introductionmentioning

confidence: 99%

Cost and cost-effectiveness of voluntary medical male circumcision in street-connected youth: findings from an education-based pilot intervention in Eldoret, Kenya

et al. 2018

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BackgroundVoluntary medical male circumcision (VMMC) is a critical component of HIV prevention. VMMC policies have achieved initial targets in adult men yet continue to fall short in reaching younger men and adolescents.SettingWe present the cost and scale-up implications of an education-based, VMMC intervention for adolescent street-connected males, for whom the street has become their home and/or source of livelihood. The intervention was piloted as part of the Engaging Street Youth in HIV Interventions Project in Eldoret, Kenya.MethodsWe used a micro-costing approach to estimate the average cost of a VMMC intervention in 116 street-connected youth. Average cost was estimated per individual and per cohort by dividing total cost per intervention by number of clients accessing the intervention over a 30-day period. Total average costs included direct and support procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs averted over a 5 and 10-year period.ResultsThe total cost of the intervention was $12,526 over the 30-day period, with an average cost per individual of $108. The direct VMMC procedure cost was approximately $9 per individual. Personnel costs contributed the greatest percentage to the total intervention cost (38.2%), with mentors and social workers representing the highest wage earners. Retreat-related and education costs contributed 51% and 13% respectively to the total average cost, with surgical equipment costs contributing less than 1%. At a cost of $108 per individual, the intervention averted 60166 DALYs in 5 years resulting in a cost per DALY averted of $267.ConclusionThe VMMC intervention was highly cost-effective in Kenya, despite the additional costs incurred to reach SCY. Further scale-up may be warranted to effectively apply this intervention in comparable populations.Electronic supplementary materialThe online version of this article (10.1186/s12981-018-0207-x) contains supplementary material, which is available to authorized users.

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Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 12 publications

References 39 publications

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review

Cost and cost-effectiveness of voluntary medical male circumcision in street-connected youth: findings from an education-based pilot intervention in Eldoret, Kenya

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