International Medical Group, Kampala, Uganda.
PLoS One. 2013 May 22;8(5):e63134. doi: 10.1371/journal.pone.0063134. Print 2013.
Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013.
To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets.
A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained.
The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20.
PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.
美国国际开发署卫生政策倡议和艾滋病规划署支持的建模工作表明，乌干达需要进行 420 万例男性医学包皮环切术（MMC）才能达到 80%的流行率。自 2010 年以来，乌干达已经完成了 38 万例包皮环切术，并设定了 2013 年 100 万例的国家目标。
评估 PrePex 与当前外科 SMC 方法相比的相对可达性和成本效益，并确定这可能对帮助实现乌干达国家 SMC 目标产生的影响。
这是一项在 2012 年 8 月至 10 月的 10 周内于坎帕拉国际医院进行的横断面描述性成本分析研究。比较了使用 PrePex 进行的 625 例包皮环切术的数据，以及在同一地点使用外科包皮环切术方法收集的之前 10000 例包皮环切术的数据。获得了伦理批准。
使用 PrePex 设备的中度不良事件（AE）比例为 2%，没有发生严重不良事件，这与外科方法相当，因此 AE 率对 PrePex 的可达性或成本效益没有影响。使用 PrePex 进行一次包皮环切术的单位成本为 30.55 美元，比当前的外科方法高 35%（7.90 美元），但 PrePex 方法将操作人员的效率提高了 60%，这意味着一个团队可以完成 24 例包皮环切术，而外科方法只能完成 15 例。将 PrePex 进行包皮环切术的成本与潜在避免的 HIV 感染的未来成本节约进行比较，其成本效益仅比当前的外科方法低 2%，在设备价格为 20 美元时。
PrePex 是一种可行的 SMC 工具，具有无与伦比的扩展潜力，但要实现国家目标，必须有效创造需求并提供经过培训的人力资源。
