XIX International AIDS Conference


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MOPDE0106 - Poster Discussion Session

A comparative analysis of two high-volume male medical circumcision (MMC) operational models with similar service delivery outcomes in different settings within Gauteng and KwaZulu-Natal provinces in South Africa: urban Centre for HIV/AIDS Prevention Stud

Presented by Nikki Soboil (South Africa).

N. Soboil1, J. Cockburn1, D. Rech2, D. Taljaard2

1SACTWU, Worker Health Program, Cape Town, South Africa, 2CHAPS, Johannesburg, South Africa

Background: In 2010 South Africa initiated rapid scale up of MMC services nationally. In support of the service delivery, CHAPS operates a “specialized fixed” VMMC programme in a large urban setting in Johannesburg, Gauteng. SWHP operates a “roving” VMMC programme in the rural district of Uthukela, KwaZulu-Natal. Both programmes have achieved similar uptake of MMC services using different operational models, with each achieving the highest number of MMCs nationally within their applicable settings.
Methods: A comparative analysis was conducted of CHAPS' “fixed site” and SWHP's “roving team” over a one year period to analyse unique attributes of each, namely: social mobilisation; staff and capital resources; extent of partnerships with district Departments of Health (DOH), service quality, and cost comparisons between models.
Results: Social mobilisation activities were similar but customised to address local customs and preferences. There was variation in staffing and capital expenditure due to CHAPS' initial capital outlay for a fixed site and its permanent team of 27 versus SWHP's skeleton team of 12 with no investment in facilities. Both programmes have strong partnerships with their district DOHs, although SWHP benefited from more support in terms of interim staffing and provision of surgical consumables. This contributed to variances in expenditure and cost per MMC by programme. Adverse events and service quality were comparable, but roving services required greater time and resources in tracking client follow up than fixed services.

Capital Expenditure550 000153 000
Salaries & Wages5 135 2223 256 688
Awareness Campaigns163 68026 400
Surgical Kits & Supplies2 774 0001 778 000
Training6 00093 300
Transport & Travel37 084123 646
Operating Overheads1 254 416544 631
Cost per 12 000 MMC procedures per annum9 920 4025 975 665
Cost per MMC Procedure (SA Rands)R 827R 498
[Table 1]

Conclusions: This comparative analysis shows models need to be customised to address the requirements of each target population group and their geographic settings. In urban settings, fixed sites, drawing on large dense surrounding populations, maintain good daily numbers and follow up rates. In rural settings, the roving model, with significant government support, is economical and effective in reaching targets and covering communities spanning large areas.

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