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An estimation of operative time requirements for the scaling up of male circumcision in Malawi

This paper is available in a repository.
This paper is available in a repository.

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Preprint: policy unknown
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Postprint: policy unknown
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Abstract

Background: Three randomized controlled trials have demonstrated the efficacy of male circumcision (MC) in the prevention of HIV transmission in predominantly heterosexual communities in Africa. In order to inform program planning and implementation for this intervention there is need to estimate the human resource requirements expected in a possible roll-out of circumcision. Materials and methods We asked surgeons from across the world the usual operative time it takes in their setting to circumcise one non-infant and one infant male. We also obtained estimates of the 2006 Malawi national population from an official government statistical source to estimate the potential demand for male circumcision. Using the duration of time a surgeon would take to circumcise a male non-infant or an infant, we estimated how many clinicians would be required to circumcise 10% to 100% of the infant or non-infant male population in Malawi. Clinician operative time was estimated in full-time equivalents (FTEs) Results There were 610 clinicians (clinical officers and physicians) eligible to provide MC in Malawi. The surgical procedure took between 0.33 to 0.50 clinician-hours for non-infants and 0.17 to 0.33 clinician-hours for infants. Providing MC to between 10% and 100% of all infants in the country would require between 0.4% and 6.2% of FTEs of all registered clinicians in the country. However to provide MC to between 10% and 100% of 15 to 24 years old males in the country would require between 2.9% and 43.6% of FTEs for all the available clinicians. If 10% to 100% of 10 to 14 years old males were the targets, this would require 8.1% to 54.2% of the clinicians' FTEs. At 50% of the population target to be circumcised, this would require 14.8% to 21.8% for infants, 2.1% - 3.15 for 10 to 14 year olds, and 14.8% to 21.8% for 15-24 year olds. Conclusion We have estimated the operative time, expressed as FTEs of the available clinician pool, to provide male circumcision to specified proportions of potential target population age-groups. This information may be useful in estimating the human resource needed to scale-up male circumcision in Malawi.