The rapid results initiative campaigns were popular until 2018 when donor funding for circumcisions stopped.
But a new analysis shows they save more money because facility-based procedures are double the cost per person.
The analysis was done in Kisumu by researchers at the Kenya Medical Research Institute alongside others from an American university.
“Our results show that the average cost of one VMMC in Kisumu county in Kenya during an RRI was Sh6,529.45 ($48.51) compared to Sh13,372.51 ($99.35) for a facility-based procedure,” they reported.
RRIs are high-output campaigns that mobilise boys and men for voluntary medical male circumcision during school holidays.
The researchers include Kemri Chief Research Officer Prof Elizabeth Bukusi, Jackline Cheruiyot, and Francesca Odhiambo from the institute.
The others are Starley Shade, Craig Cohen, Katrin Jaradeh, and Tyler Van Fleet Kingery from the University of California at San Francisco.
VMMC as a programme is implemented in traditionally non-circumcising counties where the prevalence is still below 91 per cent, ranging from 56.4 per cent to 66.7 per cent.
The researchers said funding toward VMMC is expected to decline in the coming years.
It is therefore important to identify the most sustainable ways to sustainably meet the VMMC needs of new cohorts’ eligible men, they noted.
They compared the costs of facility-based VMMC and RRI-based procedures conducted between October 2017 and September 2018 at 41 sites in Kisumu county.
They visited the facilities to assess the resources that were used to support VMMC. Such supplies included anaesthesia, surgical tools, cleaning/autoclave, personnel, per diem staff, travel costs, and utilities.
They also collected data on the number of circumcisions conducted and reviewed payrolls from 2017–2018 to identify money allocated for salaries.
From October 2017-September 2018, staff in those facilities conducted a total of 42,139 VMMCs. Of these, 21,514 (51 per cent) were conducted during routine care (facility-based) and 20,625 (49 per cent) were conducted during RRIs.
“The unit cost per VMMC conducted during the months of an RRI was $48.51 and the unit costs for months outside of RRI was $99.35,” they report in the CPC Global Public Health journal.
“This lower cost within RRI could be due to efficiency, low overhead costs and increased volume compared to the facility-based model especially as it relates to school-aged children.”
Their report is titled: “Cost comparison of a rapid results initiative against standard clinic-based model to scale-up voluntary medical male circumcision in Kenya.”
The researchers noted that while lower cost per circumcision does not ensure sustainability, scale-up of RRI may be an efficient model for HIV prevention through circumcision in Kenya.
The government launched a national VMMC strategy in 2008. The initial target of 860,000 people was achieved in 2013 and by 2015, 1.2 million circumcisions had been carried out.
The World Health Organisation recommends VMMC because it cuts the risk of female-male infection by about 60 per cent.
In 2016, US-based HIV Modelling Consortium said Kenya’s investments in VMMC would reach the break-even point in 2026, and thereafter start making huge financial savings.
“Voluntary medical male circumcision is efficient. The number of VMMC required to avert one new infection could be as low as five to 15,” John Stover, a member of the US-based HIV Modelling Consortium, told the Star in 2016.
The modelling study was carried out by the National Aids and STIs Control Programme, Avenir Health, Imperial College London, US-based Institute for Disease Modelling and consultants from Kisumu.
It costs Sh20,000 every year to keep one person on life-prolonging HIV drugs in Kenya. This means the country is already making huge savings on averted infections, but is spending more money to circumcise more people.
-Edited by SKanyara
