Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa
Background:
There is strong evidence showing that voluntary medical male circumcision (VMMC) reduces HIV incidence in men. To inform the VMMC policies and goals of 13 priority countries in eastern and southern Africa, we estimate the impact and cost of scaling up adult VMMC using updated, country-specific data.
Methods and Findings:
We use the Decision Makers' Program Planning Tool (DMPPT) to model the impact and cost of scaling up adult VMMC in Botswana, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, and Nyanza Province in Kenya. We use epidemiologic and demographic data from recent household surveys for each country. The cost of VMMC ranges from US$65.85 to US$95.15 per VMMC performed, based on a cost assessment of VMMC services aligned with the World Health Organization's considerations of models for optimizing volume and efficiencies. Results from the DMPPT models suggest that scaling up adult VMMC to reach 80% coverage in the 13 countries by 2015 would entail performing 20.34 million circumcisions between 2011 and 2015 and an additional 8.42 million between 2016 and 2025 (to maintain the 80% coverage). Such a scale-up would result in averting 3.36 million new HIV infections through 2025. In addition, while the model shows that this scale-up would cost a total of US$2 billion between 2011 and 2025, it would result in net savings (due to averted treatment and care costs) amounting to US$16.51 billion.
Conclusions:
This study suggests that rapid scale-up of VMMC in eastern and southern Africa is warranted based on the likely impact on the region's HIV epidemics and net savings. Scaling up of safe VMMC in eastern and southern Africa will lead to a substantial reduction in HIV infections in the countries and lower health system costs through averted HIV care costs.
: Please see later in the article for the Editors' Summary.
Vyšlo v časopise:
Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa. PLoS Med 8(11): e32767. doi:10.1371/journal.pmed.1001132
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001132
Souhrn
Background:
There is strong evidence showing that voluntary medical male circumcision (VMMC) reduces HIV incidence in men. To inform the VMMC policies and goals of 13 priority countries in eastern and southern Africa, we estimate the impact and cost of scaling up adult VMMC using updated, country-specific data.
Methods and Findings:
We use the Decision Makers' Program Planning Tool (DMPPT) to model the impact and cost of scaling up adult VMMC in Botswana, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, and Nyanza Province in Kenya. We use epidemiologic and demographic data from recent household surveys for each country. The cost of VMMC ranges from US$65.85 to US$95.15 per VMMC performed, based on a cost assessment of VMMC services aligned with the World Health Organization's considerations of models for optimizing volume and efficiencies. Results from the DMPPT models suggest that scaling up adult VMMC to reach 80% coverage in the 13 countries by 2015 would entail performing 20.34 million circumcisions between 2011 and 2015 and an additional 8.42 million between 2016 and 2025 (to maintain the 80% coverage). Such a scale-up would result in averting 3.36 million new HIV infections through 2025. In addition, while the model shows that this scale-up would cost a total of US$2 billion between 2011 and 2025, it would result in net savings (due to averted treatment and care costs) amounting to US$16.51 billion.
Conclusions:
This study suggests that rapid scale-up of VMMC in eastern and southern Africa is warranted based on the likely impact on the region's HIV epidemics and net savings. Scaling up of safe VMMC in eastern and southern Africa will lead to a substantial reduction in HIV infections in the countries and lower health system costs through averted HIV care costs.
: Please see later in the article for the Editors' Summary.
Zdroje
1. AuvertBTaljaardDLagardeESobngwi-TambekouJSittaR 2005 Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2 e298 doi:10.1371/journal.pmed.0020298
2. BaileyRCMosesSParkerCBAgotKMacleanI 2007 Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet 369 643 656
3. GrayRHKigoziGSerwaddaDMakumbiFWatyaS 2007 Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet 369 657 666
4. World Health Organization, Joint United Nations Programme on HIV/AIDS 2007 New data on male circumcision and HIV prevention: policy and programme implications. Available: http://libdoc.who.int/publications/2007/9789241595988_eng.pdf. Accessed 31 October 2011
5. AlsallaqRAbu-RaddadL 2008 Male circumcision is a leading factor behind the differential HIV prevalence in sub-Saharan Africa [poster MOPE0254]. XVII International AIDS Conference; Mexico City, Mexico; August 2008
6. HallettTBSinghKSmithJAWhiteRGAbu-RaddadLJ 2008 Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa. PLoS ONE 3 e2212 doi:10.1371/journal.pone.0002212
7. NagelkerkeNJMosesSde VlasSJBaileyRC 2007 Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa. BMC Infect Dis 7 16
8. WhiteRGGlynnJROrrothKKFreemanEEBakkerR 2008 Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when? AIDS 22 1841 1850
9. WilliamsBGLloyd-SmithJOGouwsEHankinsCGetzWM 2006 The potential impact of male circumcision on HIV in sub-Saharan Africa. PLoS Med 3 e262 doi:10.1371/journal.pmed.0030262
10. UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention 2009 Male circumcision for HIV prevention in high HIV prevalence settings: what can mathematical modelling contribute to informed decision making? PLoS Med 6 e1000109 doi:10.1371/journal.pmed.1000109
11. AuvertBMarseilleEKorenrompELLloyd-SmithJSittaR 2008 Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa. PLoS ONE 3 e2679 doi:10.1371/journal.pone.0002679
12. TobianAASerwaddaDQuinnTCKigoziGGravittPE 2009 Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 360 1298 1309
13. AuvertBSobngwi-TambekouJCutlerENieuwoudtMLissoubaP 2009 Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa. J Infect Dis 199 14 19
14. GrayRHSerwaddaDKongXMakumbiFKigoziG 2010 Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: a randomized trial in Rakai, Uganda. J Infect Dis 201 1455 1462
15. SerwaddaDWawerMJMakumbiFKongXKigoziG 2010 Circumcision of HIV-infected men: effects on high-risk human papillomavirus infections in a randomized trial in Rakai, Uganda. J Infect Dis 201 1463 1469
16. WawerMJTobianAAKigoziGKongXGravittPE 2011 Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. Lancet 377 209 218
17. GrayRHKigoziGSerwaddaDMakumbiFNalugodaF 2009 The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda. Am J Obstet Gynecol 200 42.e41 42.e47
18. CastellsagueXBoschFXMunozNMeijerCJShahKV 2002 Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 346 1105 1112
19. MorrisBJGrayRHCastellsagueXBoschXHalperinDH 2011 The strong protective effect of circumcision against cancer of the penis. Adv Urol 2011 812368
20. MosconiAMRoilaFGattaGTheodoreC 2005 Cancer of the penis. Crit Rev Oncol Hematol 53 165 177
21. World Health Organization, Joint United Nations Programme on HIV/AIDS 2010 Progress in male circumcision scale-up: country implementation and research update Geneva World Health Organization Available: http://www.malecircumcision.org/documents/MC_country_June2010.pdf. Accessed 25 August 2011
22. World Health Organization 2008 Male circumcision quality assurance: a guide to enhancing the safety and quality of services Geneva World Health Organization
23. World Health Organization, Joint United Nations Programme on HIV/AIDS, Jhpiego 2008 Manual for male circumcision under local anaesthesia, version 2.5C Geneva World Health Organization
24. World Health Organization 2010 Considerations for implementing models for optimizing the volume and efficiency of male circumcision services Geneva World Health Organization Available: http://www.malecircumcision.org/programs/documents/mc_MOVE_2010_web.pdf. Accessed 25 August 2011
25. BollingerLDeCormier PloskyWStoverJ 2009 Male circumcision: Decision-Makers' Program Planning Tool—calculating the costs and impacts of a male circumcision program Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
26. BrownTBaoLRafteryAESalomonJABaggaleyRF 2010 Modelling HIV epidemics in the antiretroviral era: the UNAIDS Estimation and Projection Package 2009. Sex Transm Infect 86 Suppl 2 ii3 ii10
27. StoverJ 2009 A computer program for making HIV/AIDS projections and examining the demographic and social impacts of AIDS Washington (District of Columbia) Futures Group International, Health Policy Initiative
28. CassellMMHalperinDTSheltonJDStantonD 2006 Risk compensation: the Achilles' heel of innovations in HIV prevention? BMJ 332 605 607
29. KalichmanSEatonLPinkertonS 2007 Circumcision for HIV prevention: failure to fully account for behavioral risk compensation. PLoS Med 4 e138 doi:10.1371/journal.pmed.0040138
30. Botswana National AIDS Coordinating Agency 2005 Botswana AIDS impact survey II: popular report Gaborone (Botswana) Central Statistics Office
31. Zambia Central Statistical Office, Ministry of Health, Tropical Diseases Research Centre, Zambia Uo 2009 Zambia demographic and health survey 2007 Calverton (Maryland) Macro International
32. Swaziland Central Statistical Office, Macro International 2008 Swaziland demographic and health survey 2006–07 Mbabane (Swaziland) Central Statistical Office
33. Zimbabwe Central Statistical Office, Macro International 2007 Zimbabwe demographic and health survey 2005–06 Calverton (Maryland) Macro International
34. Institut National de la Statistique du Rwanda, ORC Macro 2006 Rwanda demographic and health survey 2005 Calverton (Maryland) ORC Macro
35. Moçambique Instituto Nacional de Estatística, Ministério da Saúde, Measure DHS+/ORC Macro 2005 Moçambique Inquérito Demogràfico e de Saúde 2003 Calverton (Maryland) ORC Macro
36. Kenya National Bureau of Statistics, ICF Macro 2010 Kenya demographic and health survey 2008–09 Calverton (Maryland) ICF Macro
37. Ugandan Ministry of Health, ORC Macro 2006 Uganda HIV/AIDS sero-behavioural survey 2004–2005 Calverton (Maryland) ORC Macro
38. Namibian Ministry of Health and Social Services, Macro International I 2008 Namibia demographic and health survey 2006–07 Windhoek (Namibia) Ministry of Health and Social Services
39. Lesotho Ministry of Health and Social Welfare, Lesotho Bureau of Statistics, ORC Macro 2005 Lesotho demographic and health survey 2004 Calverton (Maryland) ORC Macro
40. Malawi National Statistical Office, ORC Macro 2005 Malawi demographic and health survey 2004 Calverton (Maryland) ORC Macro
41. ShisanaORehleTSimbayiLCZumaKJoosteS 2009 South African national HIV prevalence, incidence, behaviour and communication survey 2008: A turning tide among teenagers? Cape Town HSRC Press
42. Tanzania Commission for AIDS, Zanzibar AIDS Commission, National Bureau of Statistics, Office of the Chief Government Statistician, Macro International 2008 Tanzania HIV/AIDS and malaria indicator survey 2007–08 Dar es Salaam (Tanzania) Tanzania Commission for AIDS
43. StoverJKirmeyerS 2008 DemProj: A computer program for making population projections Washington (District of Columbia) Futures Group International, Health Policy Initiative
44. United Nations Population Division 2008 World population prospects: the 2008 revision New York United Nations Department of Economic and Social Affairs
45. ChiwevuCM 2010 Costing of male circumcision in Zambia and the impacts of scaling up the male circumcision programme Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
46. ForsytheS 2010 Costing of male circumcision in Namibia and the impacts of scaling up the male circumcision program Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
47. KiokoU 2010 Costing of male circumcision in Kenya and the impacts of scaling up the male circumcision programme Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
48. Makerere University School of Public Health 2010 Assessing the potential impact and costs of scaling up medical male circumcision services in Uganda Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
49. OzayrMAsmalSForsytheSNjeuhmeliE 2010 Costing of male circumcision in South Africa and impacts of scaling up the circumcision programme Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
50. SchutteCForsytheS 2010 Costing of male circumcision in Zimbabwe and impacts of scaling up the circumcision programme Washington (District of Columbia) Futures Group, Health Policy Initiative, Task Order 1
51. Numbeo 2011 Cost of living comparison between two countries [database]. Available: http://www.numbeo.com/cost-of-living/compare_countries.jsp. Accessed 25 August 2011
52. EdgilDStankardPSForsytheSReedJRechD 2011 Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services. PLoS Med 8 e1001128 doi:10.1371/journal.pmed.1001128
53. SchwartlanderBStoverJHallettTAtunRAvilaC 2011 Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377 2031 2041
54. DrummondMFO'BrienBStoddartGLTorranceGW 1999 Methods for the economic evaluation of health care programmes Oxford Oxford University Press
55. HaddixACTeutschSMShafferPADunetDO 1996 Prevention effectiveness: a guide to decision analysis and economic evaluation Oxford Oxford University Press
56. LissoubaPTaljaardDRechDDermaux-MsimangVLegeaiC 2011 Adult male circumcision as an intervention against HIV: an operational study of uptake in a South African community (ANRS 12126). BMC Infect Dis 11 253
57. WawerMJMakumbiFKigoziGSerwaddaDWatyaS 2009 Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 374 229 237
58. GalarragaOColcheroMAWamaiRGBertozziSM 2009 HIV prevention cost-effectiveness: a systematic review. BMC Public Health 9 Suppl 1 S5
59. GrayRHLiXKigoziGSerwaddaDNalugodaF 2007 The impact of male circumcision on HIV incidence and cost per infection prevented: a stochastic simulation model from Rakai, Uganda. AIDS 21 845 850
60. ThomasAGTranBRCranstonMBrownMCKumarR 2011 Voluntary medical male circumcision: a cross-sectional study comparing circumcision self-report and physical examination findings in Lesotho. PLoS ONE 6 e0027561 doi:10.1371/journal.pone.002756
61. BinagwahoAPegurriEMuitaJBertozziS 2010 Male circumcision at different ages in Rwanda: A cost-effectiveness study. PLoS Med 7 e1000211 doi:10.1371/journal.pmed.1000211
62. KahnJGMarseilleEAuvertB 2006 Cost-effectiveness of male circumcision for HIV prevention in a South African setting. PLoS Med 3 e517 doi:10.1371/journal.pmed.0030517
63. Bautista-ArredondoSGadsdenPHarrisJEBertozziSM 2008 Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework. AIDS 22 Suppl 1 S67 S74
64. MarseilleEDandonaLMarshallNGaistPBautista-ArredondoS 2007 HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries. BMC Health Serv Res 7 108
65. BertrandJTNjeuhmeliEForsytheSMattisonSKChideyaS 2011 Voluntary medical male circumcision: a qualitative study exploring the challenges of costing demand creation in eastern and southern Africa. PLoS ONE 6 e0027562 doi:10.1371/journal.pone.0027562
66. CohenMSChenYQMcCauleyMGambleTHosseinipourMC 2011 Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365 493 505
67. World Health Organization, Joint United Nations Programme on HIV/AIDS, United Nations Children's Fund 2010 Towards universal access: scaling up priority HIV/AIDS interventions in the health sector Geneva World Health Organization Available: http://whqlibdoc.who.int/publications/2010/9789241500395_eng.pdf. Accessed 25 August 2011
68. MwandiZMurphyAReedJChesangKNjeuhmeliE 2011 Voluntary medical male circumcision: translating research into the rapid expansion of services in Kenya, 2008–2011. PLoS Med 8 e1001130 doi:10.1371/journal.pmed.1001130
69. MahlerHRKileoBCurranKPlotkinMAdamuT 2011 Voluntary medical male circumcision: matching demand and supply with quality and efficiency in a high-volume campaign in Iringa Region, Tanzania. PLoS Med 8 e1001131 doi:10.1371/journal.pmed.1001131
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2011 Číslo 11
- Statiny indukovaná myopatie: Jak na diferenciální diagnostiku?
- MUDr. Dana Vondráčková: Hepatopatie sú pri liečbe metamizolom väčším strašiakom ako agranulocytóza
- Vztah mezi statiny a rizikem vzniku nádorových onemocnění − metaanalýza
- Nech brouka žít… Ať žije astma!
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
Najčítanejšie v tomto čísle
- Evidence-Based Guidelines for Mental, Neurological, and Substance Use Disorders in Low- and Middle-Income Countries: Summary of WHO Recommendations
- Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa
- Rapid Diagnosis of Tuberculosis with the Xpert MTB/RIF Assay in High Burden Countries: A Cost-Effectiveness Analysis
- Physical Activity Attenuates the Influence of Variants on Obesity Risk: A Meta-Analysis of 218,166 Adults and 19,268 Children