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Estimating male circumcision resource requirements - a program manager's tool
J. Campbell, J. Fast, J. Yarrow, M. O'Brien
Clinton Foundation HIV/AIDS Initiative, Center for Strategic HIV/AIDS Operations Research, Boston, United States
Background: Male circumcision (MC) has been found to be effective in reducing HIV transmission to males through heterosexual intercourse. WHO and UNAIDS now recommend including MC as part of a comprehensive HIV prevention package, and several national and regional programs are scaling up services in a bid to quell incidence. MC scale-up is occurring in resource-limited areas, where careful planning of resource allocation will be essential to maximize intervention effectiveness given capacity constraints.
Methods: We created a male circumcision resource forecasting tool (MCRF) in MS Excel to help inform program planning. MCRF is designed to be used by program managers to estimate resource needs; specifically, it can calculate (1) resources needed for a 5-year program with a given number of theaters, (2) resources and number of years required to reach a target coverage and (3) resources required to reach a target coverage or quantity in a specified number of years. The tool uses default or user inputted data including: demographics, acceptability rates, clinic procedures, and supplies. It estimates annual MC volumes, coverage rates, human resource and theater requirements, and program costs.
Results: A hypothetical population of 200,000 males and characteristic inputs for sub-Saharan Africa determined the resources required to achieve 70% coverage in 5 years. Results showed that 10.3 theaters and 10.4 full-time equivalent (FTE) physicians (or nurses performing surgery) would be required to provide the 30,000 average annual MCs needed to achieve this target. An example of an alternative scenario, increasing the program length to 6 years results in averages of 8.8 theaters and 8.9 FTE physicians needed for 26,000 surgeries annually.
Conclusions: Accurate program planning is essential for effective MC scale up in resource-limited settings. Tools can facilitate informed planning by allowing users to estimate resource needs under alternative scenarios and to select a strategy that will achieve goals while optimizing resources.
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