Department of Population Health, New York University Grossman School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
Department of Decision Sciences, College of Economic and Management Sciences, University of South Africa, Pretoria, Gauteng, South Africa.
Curr HIV/AIDS Rep. 2022 Dec;19(6):526-536. doi: 10.1007/s11904-022-00639-5. Epub 2022 Dec 2.
Voluntary male medical circumcision (VMMC) has been a cornerstone of HIV prevention in Eastern and Southern Africa (ESA) and is credited in part for declines in HIV incidence seen in recent years. However, these HIV incidence declines change VMMC cost-effectiveness and how it varies across populations.
Mathematical models project continued cost-effectiveness of VMMC in much of ESA despite HIV incidence declines. A key data gap is how demand generation cost differs across age groups and over time as VMMC coverage increases. Additionally, VMMC models usually neglect non-HIV effects of VMMC, such as prevention of other sexually transmitted infections and medical adverse events. While small compared to HIV effects in the short term, these could become important as HIV incidence declines. Evidence to date supports prioritizing VMMC in ESA despite falling HIV incidence. Updated modeling methodologies will become necessary if HIV incidence reaches low levels.
目的综述：自愿男性医疗包皮环切术（VMMC）是东非和南非（ESA）艾滋病毒预防的基石，近年来艾滋病毒发病率的下降在一定程度上归因于该手术。然而，这些艾滋病毒发病率的下降改变了 VMMC 的成本效益，以及它在不同人群中的变化。
最新发现：数学模型预测，尽管艾滋病毒发病率下降，但 VMMC 在 ESA 的大部分地区仍具有持续的成本效益。一个关键的数据差距是，随着 VMMC 覆盖率的增加，需求产生成本在不同年龄段和不同时间的差异。此外，VMMC 模型通常忽略了 VMMC 的非艾滋病毒效应，如预防其他性传播感染和医疗不良事件。虽然与短期的艾滋病毒效应相比，这些影响较小，但随着艾滋病毒发病率的下降，这些影响可能变得重要。迄今为止的证据支持在 ESA 中优先考虑 VMMC，尽管艾滋病毒发病率正在下降。如果艾滋病毒发病率达到低水平，将需要更新的建模方法。
