Zhang Chen, Penson David F, Qian Han-Zhu, Webb Glenn F, Lou Jie, Shephard Brian E, Liu Yu, Vermund Sten H
1 School of Nursing, University of Rochester Medical Center, Rochester, NY, USA.
*These authors contributed equally to this work.
Int J STD AIDS. 2019 Jun;30(7):630-638. doi: 10.1177/0956462419831859. Epub 2019 Mar 19.
Voluntary medical male circumcision (VMMC) among men who have sex with men (MSM) may protect against HIV acquisition. We conducted a series of analyses to assess if expanded VMMC might reduce HIV incidence among MSM effectively and economically. We used a deterministic compartmental model to project new HIV cases (2016-2026) under annual VMMC coverage rates (λ) ranging from 0.0001 to 0.15. The 'number needed to avert' (NNA) is defined as the cumulative number of VMMCs conducted up to that year divided by the cumulative number of HIV cases averted in that specific year. Compared with the baseline circumcision coverage rate, we projected that new HIV cases would be reduced with increasing coverage. By 2026 (last year simulated), the model generated the lowest ratio (11.10) when the annual circumcision rate was the most optimistic (λ = 0.15). The breakeven point was observed at the year of 2019 with the annual VMMC coverage rate of 0.001. The total cost saved by averting HIV cases would range from 2.5 to 811 million US dollars by the end of 2026 with different hypothetical coverage rates. Our model suggests that acceleration in VMMC implementation among MSM could help stem the HIV/AIDS epidemic.
男男性行为者（MSM）中的自愿男性包皮环切术（VMMC）可能预防感染艾滋病毒。我们进行了一系列分析，以评估扩大VMMC是否能有效且经济地降低MSM中的艾滋病毒发病率。我们使用确定性房室模型来预测在年VMMC覆盖率（λ）从0.0001到0.15范围内（2016 - 2026年）的新增艾滋病毒病例。“避免感染所需人数”（NNA）定义为截至该年进行的VMMC累计数量除以该特定年份避免的艾滋病毒病例累计数量。与基线包皮环切覆盖率相比，我们预计随着覆盖率的增加，新增艾滋病毒病例会减少。到2026年（模拟的最后一年），当年包皮环切率最乐观（λ = 0.15）时，模型得出的比率最低（11.10）。在2019年观察到盈亏平衡点，年VMMC覆盖率为0.001。到2026年底，通过不同假设覆盖率避免艾滋病毒病例所节省的总成本将在2.5亿美元至8.11亿美元之间。我们的模型表明，加快在MSM中实施VMMC有助于遏制艾滋病毒/艾滋病疫情。
