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Trends in the Marginal Cost of Male Circumcision in Rural Rakai Uganda.

Trends in the Marginal Cost of Male Circumcision in Rural Rakai Uganda.
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Alfonso YN, Bishai D, Nantongo A, Kakembo R, Kobusinge S, Kacker S, Kigozi G, Gray R,


Alfonso YN, Bishai D, Nantongo A, Kakembo R, Kobusinge S, Kacker S, Kigozi G, Gray R, (click to view)

Alfonso YN, Bishai D, Nantongo A, Kakembo R, Kobusinge S, Kacker S, Kigozi G, Gray R,

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Journal of acquired immune deficiency syndromes (1999) 73(5) 564-571

Abstract
INTRODUCTION
Male circumcision (MC) is an effective intervention to reduce HIV acquisition in men in Africa. We conducted a cost analysis using longitudinal data on expenditures on services and community mobilization to estimate the marginal cost of MC over time and understand cost drivers during scale-up.

METHODS
We used a time series with monthly records from 2008 to 2013, for a total of 72 monthly observations, from the Rakai MC Program in Uganda. Generalized linear models were used to estimate the marginal cost of an MC procedure.

RESULTS
The marginal cost per MC in a mobile camp was $23 (P < 0.01) and in static facilities was $35 (P < 0.1). Major cost drivers included supplies in mobile camps with increasing numbers of surgeries, savings due to task shifting from physicians to clinical officers, and increased efficiency as personnel became more experienced. CONCLUSIONS
As scale-up continues, marginal costs may increase because of mobilization needed for less motivated late adopters, but improved efficiency could contain costs.

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