Comparing Direct Costs of Facility-Based Shang Ring Provision Versus a Standard Surgical Technique for Voluntary Medical Male Circumcision in Zambia

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Rapid scale-up of voluntary medical male circumcision (VMMC) is needed to realize potential reductions in HIV incidence in sub-Saharan Africa. New disposable VMMC devices such as the Shang Ring may offer several advantages over standard surgery, including lower costs.


We compared direct costs of the Shang Ring and dorsal slit techniques for delivery of VMMC in the context of a randomized-controlled trial carried out in Zambia in 2011. Information on direct costs of clinician time, disposable supplies, and reusable medical instruments were collected by study staff.


During the trial, the direct cost of 1 VMMC procedure using the Shang Ring device was US $18.21, whereas the direct cost of using dorsal slit was US $17.67. Higher costs of clinician time related to dorsal slit VMMC were offset by higher costs of disposable supplies with the Shang Ring approach.


Although direct costs were roughly equivalent during this small-scale trial, with the increased demand from scaling up VMMC, a Shang Ring team could provide services at a substantially lower average total cost due to the potential for more intensive use of staff and other fixed resources.

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