Voluntary
Medical Male Circumcision: Modeling the Impact and Cost of Expanding
Male Circumcision for HIV Prevention in Eastern and Southern Africa
Njeuhmeli E, Forsythe S, Reed J, Opuni M, Bollinger L, et al. (2011) 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):
e1001132.
doi:10.1371/journal.pmed.1001132
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.
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