The Palladium Group, Washington DC, United States of America.
USAID/Mozambique, Maputo, Mozambique.
PLoS One. 2019 Feb 22;14(2):e0211958. doi: 10.1371/journal.pone.0211958. eCollection 2019.
The voluntary medical male circumcision (VMMC) program in Mozambique aimed to increase male circumcision (MC) coverage to 80 percent among males ages 10 to 49 by 2018. Given the difficulty in attracting adult men over age 20 for circumcision, Mozambique became interested in assessing its age-targeting strategy and progress at the provincial level to inform program planning.
We examined the impact and cost-effectiveness of circumcising different age groups of men using the Decision Makers' Program Planning Toolkit, Version 2.1 (DMPPT 2). We also applied the model to assess the scale-up efforts through the end of September 2017 and project their impact on HIV incidence through 2030. The DMPPT 2 is a compartmental Excel-based model that analyzes the effects of age at circumcision on program impact and cost-effectiveness. The model tracks changes in age-specific MC coverage due to VMMC program circumcisions. Baseline MC prevalence was based on data from the 2011 Demographic and Health Survey. The DMPPT 2 was populated with HIV incidence projections from Spectrum/Goals under an assumption that Mozambique would reach its national targets for HIV treatment and prevention by 2022.
We estimate the VMMC program increased MC coverage among males ages 10 to 49 from 27 percent in 2009 to 48 percent by end of September 2017. Coverage increased primarily in males ages 10 to 29. VMMCs conducted in the national program through the end of September 2017 are projected to avert 67,076 HIV infections from 2010 to 2030. Scaling up circumcisions in males ages 20 to 29 will have the most immediate impact on HIV incidence, while the greatest impact over a 15-year period is obtained by circumcising males ages 15 to 24 in the majority of priority provinces. Circumcising 80 percent of males ages 10 to 29 can achieve 77 percent of the impact through 2030 compared with circumcising 80 percent of males ages 10 to 49.
The VMMC program in Mozambique has made great strides in increasing MC coverage, particularly for males ages 10 to 29. Scaling up and maintaining MC coverage in this age group offers an attainable and cost-effective target for VMMC in Mozambique.
莫桑比克的自愿男性割礼（VMMC）计划旨在到 2018 年将 10 至 49 岁男性的割礼覆盖率提高到 80%。由于难以吸引 20 岁以上的成年男性进行割礼，莫桑比克开始评估其省级年龄定位策略和进展情况，为规划方案提供依据。
我们使用决策制定者规划工具包（DMPPT 2）版本 2.1 评估了为不同年龄组男性进行割礼的影响和成本效益。我们还应用该模型评估了截至 2017 年 9 月底的推广工作，并预测其对 2030 年之前艾滋病毒发病率的影响。DMPPT 2 是一个基于 Excel 的分区模型，用于分析割礼年龄对项目影响和成本效益的影响。该模型跟踪由于 VMMC 项目割礼而导致的特定年龄组割礼覆盖率的变化。基线割礼流行率基于 2011 年人口与健康调查的数据。DMPPT 2 中包含了 Spectrum/Goals 的艾滋病毒发病率预测，假设莫桑比克将在 2022 年前实现其国家艾滋病毒治疗和预防目标。
我们估计，到 2017 年 9 月底，VMMC 计划将 10 至 49 岁男性的割礼覆盖率从 2009 年的 27%提高到 48%。覆盖率的增加主要发生在 10 至 29 岁的男性中。截至 2017 年 9 月底，国家规划中开展的 VMMC 预计将在 2010 年至 2030 年期间预防 67076 例艾滋病毒感染。在大多数重点省份，为 20 至 29 岁的男性扩大割礼范围将对艾滋病毒发病率产生最直接的影响，而在 15 年内产生最大影响的是为 15 至 24 岁的男性进行割礼。在 10 至 29 岁的男性中实现 80%的割礼覆盖率，与在 10 至 49 岁的男性中实现 80%的割礼覆盖率相比，可实现 77%的效果。
莫桑比克的 VMMC 计划在提高割礼覆盖率方面取得了长足进展，特别是在 10 至 29 岁的男性中。在这一年龄组中扩大和维持割礼覆盖率为莫桑比克的 VMMC 提供了一个可行和具有成本效益的目标。
