Abstract:
Background: 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.
Setting: 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.
Methods: 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 sup‐
port procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs
averted over a 5 and 10-year period.
Results: 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.
Conclusion: 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.
