The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.

Uganda is working to increase voluntary medical male circumcision (VMMC) to prevent HIV infection. To support VMMC quality improvement, this study compared three methods of disseminating information to facilities on how to improve VMMC quality: M-providing a written manual; MH-providing the manual p...

Full description

Bibliographic Details
Main Authors: Edward I Broughton, Esther Karamagi, Angella Kigonya, Anna Lawino, Lani Marquez, Sarah Smith Lunsford, Albert Twinomugisha
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2018-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC5908073?pdf=render
id doaj-3d89a04654ed42edadfbdfc5ae268f1b
record_format Article
spelling doaj-3d89a04654ed42edadfbdfc5ae268f1b2020-11-24T22:11:46ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01134e019569110.1371/journal.pone.0195691The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.Edward I BroughtonEsther KaramagiAngella KigonyaAnna LawinoLani MarquezSarah Smith LunsfordAlbert TwinomugishaUganda is working to increase voluntary medical male circumcision (VMMC) to prevent HIV infection. To support VMMC quality improvement, this study compared three methods of disseminating information to facilities on how to improve VMMC quality: M-providing a written manual; MH-providing the manual plus a handover meeting in which clinicians shared advice on implementing key changes and participated in group discussion; and MHC-manual, handover meeting, and three site visits to the facility in which a coach provided individualized guidance and mentoring on improvement. We determined the different effects these had on compliance with indicators of quality of care.This controlled pre-post intervention study randomized health facility groups to receive M, MH, or MHC. Observations of VMMCs performance determined compliance with quality indicators. Intervention costs per patient receiving VMMC were used in a decision-tree cost-effectiveness model to calculate the incremental cost per additional patient treated to compliance with indicators of informed consent, history taking, anesthesia administration, and post-operative instructions.The most intensive method (MHC) cost $28.83 per patient and produced the biggest gains in history taking (35% improvement), anesthesia administration (20% improvement), and post-operative instructions (37% improvement). The least intensive method (M; $1.13 per patient) was most efficient because it produced small gains for a very low cost. The handover meeting (MH) was the most expensive among the three interventions but did not have a corresponding positive effect on quality.Health workers in facilities that received the VMMC improvement manual and participated in the handover meeting and coaching visits showed more improvement in VMMC quality indicators than those in the other two intervention groups. Providing the manual alone cost the least but was also the least effective in achieving improvements. The MHC intervention is recommended for broader implementation to improve VMMC quality in Uganda.http://europepmc.org/articles/PMC5908073?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Edward I Broughton
Esther Karamagi
Angella Kigonya
Anna Lawino
Lani Marquez
Sarah Smith Lunsford
Albert Twinomugisha
spellingShingle Edward I Broughton
Esther Karamagi
Angella Kigonya
Anna Lawino
Lani Marquez
Sarah Smith Lunsford
Albert Twinomugisha
The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.
PLoS ONE
author_facet Edward I Broughton
Esther Karamagi
Angella Kigonya
Anna Lawino
Lani Marquez
Sarah Smith Lunsford
Albert Twinomugisha
author_sort Edward I Broughton
title The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.
title_short The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.
title_full The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.
title_fullStr The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.
title_full_unstemmed The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.
title_sort cost-effectiveness of three methods of disseminating information to improve medical male circumcision in uganda.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2018-01-01
description Uganda is working to increase voluntary medical male circumcision (VMMC) to prevent HIV infection. To support VMMC quality improvement, this study compared three methods of disseminating information to facilities on how to improve VMMC quality: M-providing a written manual; MH-providing the manual plus a handover meeting in which clinicians shared advice on implementing key changes and participated in group discussion; and MHC-manual, handover meeting, and three site visits to the facility in which a coach provided individualized guidance and mentoring on improvement. We determined the different effects these had on compliance with indicators of quality of care.This controlled pre-post intervention study randomized health facility groups to receive M, MH, or MHC. Observations of VMMCs performance determined compliance with quality indicators. Intervention costs per patient receiving VMMC were used in a decision-tree cost-effectiveness model to calculate the incremental cost per additional patient treated to compliance with indicators of informed consent, history taking, anesthesia administration, and post-operative instructions.The most intensive method (MHC) cost $28.83 per patient and produced the biggest gains in history taking (35% improvement), anesthesia administration (20% improvement), and post-operative instructions (37% improvement). The least intensive method (M; $1.13 per patient) was most efficient because it produced small gains for a very low cost. The handover meeting (MH) was the most expensive among the three interventions but did not have a corresponding positive effect on quality.Health workers in facilities that received the VMMC improvement manual and participated in the handover meeting and coaching visits showed more improvement in VMMC quality indicators than those in the other two intervention groups. Providing the manual alone cost the least but was also the least effective in achieving improvements. The MHC intervention is recommended for broader implementation to improve VMMC quality in Uganda.
url http://europepmc.org/articles/PMC5908073?pdf=render
work_keys_str_mv AT edwardibroughton thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT estherkaramagi thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT angellakigonya thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT annalawino thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT lanimarquez thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT sarahsmithlunsford thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT alberttwinomugisha thecosteffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT edwardibroughton costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT estherkaramagi costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT angellakigonya costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT annalawino costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT lanimarquez costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT sarahsmithlunsford costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
AT alberttwinomugisha costeffectivenessofthreemethodsofdisseminatinginformationtoimprovemedicalmalecircumcisioninuganda
_version_ 1725804273444323328