Costing adult male circumcision in high HIV prevalence, low circumcision rate countries

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Abstract
The dramatic evidence that male circumcision has a substantial effect in preventing HIV infection might be the most important medical finding in the course of the AIDS epidemic since the introduction of highly active antiretroviral therapy (HAART). The transition from clinical trails to implementation of a general adult male circumcision (AMC) program is beginning, and this paper uses an AMC cost model (in Microsoft Excel) to estimate the cost of a rapid scale-up of an AMC program in Mozambique, a country with a generalized epidemic and low rate of male circumcision. There are three major findings: (1) Even the most modest of AMC programs would place great stress on human resources, and task-shifting might lead to more accidents or adverse events that would increase the cost per AMC. (2) The fiscal burden of AMC is surprisingly low, but a rapid scale-up of AMC poses additional fiscal stress for Mozambique's already under-funded public health system. (3) AMC as an HIV prevention tool is very robust in terms of its cost-effectiveness in Mozambique, even at a high AMC accident or complication rate. Any AMC roll-out in Mozambique would face severe constraints in the health system (namely human resources) that would likely limit the scale of an AMC program and perhaps its effectiveness against its generalized epidemic.

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