Galárraga O, Shah P, Wilson-Barthes M, Ayuku D, Braitstein P
International Health Institute, Brown University School of Public Health, Providence, RI, USA.
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
AIDS Res Ther. 2018 Nov 29;15(1):24. doi: 10.1186/s12981-018-0207-x.
Voluntary medical male circumcision (VMMC) is a critical component of HIV prevention. VMMC policies have achieved initial targets in adult men yet continue to fall short in reaching younger men and adolescents.
We present the cost and scale-up implications of an education-based, VMMC intervention for adolescent street-connected males, for whom the street has become their home and/or source of livelihood. The intervention was piloted as part of the Engaging Street Youth in HIV Interventions Project in Eldoret, Kenya.
We used a micro-costing approach to estimate the average cost of a VMMC intervention in 116 street-connected youth. Average cost was estimated per individual and per cohort by dividing total cost per intervention by number of clients accessing the intervention over a 30-day period. Total average costs included direct and support procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs averted over a 5 and 10-year period.
The total cost of the intervention was $12,526 over the 30-day period, with an average cost per individual of $108. The direct VMMC procedure cost was approximately $9 per individual. Personnel costs contributed the greatest percentage to the total intervention cost (38.2%), with mentors and social workers representing the highest wage earners. Retreat-related and education costs contributed 51% and 13% respectively to the total average cost, with surgical equipment costs contributing less than 1%. At a cost of $108 per individual, the intervention averted 60166 DALYs in 5 years resulting in a cost per DALY averted of $267.
The VMMC intervention was highly cost-effective in Kenya, despite the additional costs incurred to reach SCY. Further scale-up may be warranted to effectively apply this intervention in comparable populations.
自愿男性医学包皮环切术（VMMC）是预防艾滋病病毒的关键组成部分。VMMC政策已在成年男性中实现了初步目标，但在覆盖年轻男性和青少年方面仍有不足。
我们介绍了一项针对与街头有联系的青少年男性的基于教育的VMMC干预措施的成本及扩大规模的影响，对他们而言，街头已成为他们的家或生计来源。该干预措施作为肯尼亚埃尔多雷特“让街头青年参与艾滋病干预项目”的一部分进行了试点。
我们采用微观成本核算方法来估算对116名与街头有联系的青年进行VMMC干预的平均成本。通过将每次干预的总成本除以30天内接受干预的客户数量，来估算每人及每个队列的平均成本。总平均成本包括直接和支持程序成本、教育成本以及直接研究成本。成本效益通过5年和10年内每避免一个伤残调整生命年（DALY）的成本来衡量。
在30天内，干预措施的总成本为12,526美元，人均成本为108美元。直接的VMMC程序成本约为每人9美元。人员成本在总干预成本中所占比例最大（38.2%），其中导师和社会工作者的工资最高。与静修相关的成本和教育成本分别占总平均成本的51%和13%，手术设备成本占比不到1%。每人成本为108美元时，该干预措施在5年内避免了60166个DALY，导致每避免一个DALY的成本为267美元。
尽管为覆盖与街头有联系的青年产生了额外成本，但VMMC干预措施在肯尼亚具有很高的成本效益。可能有必要进一步扩大规模，以便在类似人群中有效应用这一干预措施。
