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Randomized Controlled Trial
. 2023 Nov 16;18(11):e0294449.
doi: 10.1371/journal.pone.0294449. eCollection 2023.

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Yanfang Su  1 , Rachel Mukora  2 , Felex Ndebele  2 , Jacqueline Pienaar  2   3 , Calsile Khumalo  2 , Xinpeng Xu  4 , Hannock Tweya  1   5 , Maria Sardini  3 , Sarah Day  3   6 , Kenneth Sherr  1 , Geoffrey Setswe  2   7 , Caryl Feldacker  1   5
Affiliations
Randomized Controlled Trial

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Yanfang Su et al. PLoS One. .

Abstract

Introduction: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings.

Methods: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings.

Results: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively.

Conclusion: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Costs in USD for routine care and 2wT per client (USD).
Fig 2
Fig 2. Cost changes by implementing 2WT compared to the routine, rural vs. urban (USD).
See this image and copyright information in PMC

Update of

References

    1. Titus MJ, Moodley J. Male circumcision as a public health measure for the prevention of HIV transmission. Southern African Journal of Epidemiology and Infection. 2011;26(4):262–5.
    1. Bershteyn A, Mudimu E, Platais I, Mwalili S, Zulu JE, Mwanza WN, et al. Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges. Curr HIV/AIDS Rep. 2022;19(6):526–36. Epub 2022/12/03. doi: 10.1007/s11904-022-00639-5 ; PubMed Central PMCID: PMC9759505. - DOI - PMC - PubMed
    1. Hellar A, Plotkin M, Lija G, Mwanamsangu A, Mkungume S, Christensen A, et al. Adverse events in a large-scale VMMC programme in Tanzania: findings from a case series analysis. J Int AIDS Soc. 2019;22(7):e25369. Epub 2019/08/02. doi: 10.1002/jia2.25369 ; PubMed Central PMCID: PMC6669321. - DOI - PMC - PubMed
    1. Muchiri E, Charalambous S, Ginindza S, Maraisane M, Maringa T, Vranken P, et al. Description of adverse events among adult men following voluntary medical male circumcision: Findings from a circumcision programme in two provinces of South Africa. PloS one. 2021;16(8):e0253960. Epub 2021/08/18. doi: 10.1371/journal.pone.0253960 ; PubMed Central PMCID: PMC8370616. - DOI - PMC - PubMed
    1. Omollo V, Marongwe P, Vernon M, Thoko M, Paidamoyo G, Farai G, et al. Adverse event trends within a large-scale, routine, voluntary medical male circumcision program in Zimbabwe, 2014–2019. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2021;88(2):173–80. doi: 10.1097/QAI.0000000000002751 - DOI - PMC - PubMed

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