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Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces.

作者信息

Kripke Katharine, Chen Ping-An, Vazzano Andrea, Thambinayagam Ananthy, Pillay Yogan, Loykissoonlal Dayanund, Bonnecwe Collen, Barron Peter, Kiwango Eva, Castor Delivette, Njeuhmeli Emmanuel

机构信息

Health Policy Project, Avenir Health, Washington, District of Columbia, United States of America.

Health Policy Project, Futures Group, Washington, District of Columbia, United States of America.

出版信息

PLoS One. 2016 Jul 13;11(7):e0157071. doi: 10.1371/journal.pone.0157071. eCollection 2016.


DOI:10.1371/journal.pone.0157071
PMID:27409079
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4943592/
Abstract

BACKGROUND: In 2012, South Africa set a goal of circumcising 4.3 million men ages 15-49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC). In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographic locations would be particularly impactful or cost-effective. Results will inform South Africa's efforts to develop a national strategy and operational plan for VMMC. METHODS AND FINDINGS: The study team populated the Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0) with HIV incidence projections from the Spectrum/AIDS Impact Module (AIM), as well as national and provincial population and HIV prevalence estimates. We derived baseline circumcision rates from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The model showed that circumcising men ages 20-34 offers the most immediate impact on HIV incidence and requires the fewest circumcisions per HIV infection averted. The greatest impact over a 15-year period is achieved by circumcising men ages 15-24. When the model assumes a unit cost increase with client age, men ages 15-29 emerge as the most cost-effective group. When we assume a constant cost for all ages, the most cost-effective age range is 15-34 years. Geographically, the program is cost saving in all provinces; differences in the VMMC program's cost-effectiveness across provinces were obscured by uncertainty in HIV incidence projections. CONCLUSION: The VMMC program's impact and cost-effectiveness vary by age-targeting strategy. A strategy focusing on men ages 15-34 will maximize program benefits. However, because clients older than 25 access VMMC services at low rates, South Africa could consider promoting demand among men ages 25-34, without denying services to those in other age groups. Uncertainty in the provincial estimates makes them insufficient to support geographic targeting.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/45f08f754aca/pone.0157071.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/60212ad4e8cb/pone.0157071.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/43e315ea430f/pone.0157071.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/45f08f754aca/pone.0157071.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/60212ad4e8cb/pone.0157071.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/43e315ea430f/pone.0157071.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f227/4943592/45f08f754aca/pone.0157071.g003.jpg

相似文献

[1]
Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces.

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[2]
A cross-sectional study of the factors associated with male circumcision status among college youth in Ndola, Zambia, 2016.

South Afr J HIV Med. 2019-6-20

[3]
Substantial but spatially heterogeneous progress in male circumcision for HIV prevention in South Africa.

Commun Med (Lond). 2024-1-3

[4]
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PLoS One. 2023

[5]
Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.

Lancet Glob Health. 2023-2

[6]
Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges.

Curr HIV/AIDS Rep. 2022-12

[7]
An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25-49 years in South Africa.

BMC Health Serv Res. 2021-10-15

[8]
Description of adverse events among adult men following voluntary medical male circumcision: Findings from a circumcision programme in two provinces of South Africa.

PLoS One. 2021

[9]
The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models.

Gates Open Res. 2021-1-25

[10]
Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa.

BMC Med. 2020-7-7

本文引用的文献

[1]
The Cost of Voluntary Medical Male Circumcision in South Africa.

PLoS One. 2016-10-26

[2]
Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014.

PLoS One. 2016-7-21

[3]
Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers' Program Planning Toolkit (DMPPT) 2.0.

PLoS One. 2016-7-13

[4]
New insights into HIV epidemic in South Africa: key findings from the National HIV Prevalence, Incidence and Behaviour Survey, 2012.

Afr J AIDS Res. 2016

[5]
Updates to the spectrum model to estimate key HIV indicators for adults and children.

AIDS. 2014-11

[6]
Understanding and addressing socio-cultural barriers to medical male circumcision in traditionally non-circumcising rural communities in sub-Saharan Africa.

Cult Health Sex. 2013-7-1

[7]
Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa.

PLoS Med. 2011-11-29

[8]
Medical circumcision and manhood initiation rituals in the Eastern Cape, South Africa: a post intervention evaluation.

Cult Health Sex. 2009-1

[9]
Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.

Lancet. 2007-2-24

[10]
Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.

Lancet. 2007-2-24

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