10.1371/journal.pone.0199453 Jessica B. McGillen Jessica B. McGillen John Stover John Stover Daniel J. Klein Daniel J. Klein Sinokuthemba Xaba Sinokuthemba Xaba Getrude Ncube Getrude Ncube Mutsa Mhangara Mutsa Mhangara Geraldine N. Chipendo Geraldine N. Chipendo Isaac Taramusi Isaac Taramusi Leo Beacroft Leo Beacroft Timothy B. Hallett Timothy B. Hallett Patrick Odawo Patrick Odawo Rumbidzai Manzou Rumbidzai Manzou Eline L. Korenromp Eline L. Korenromp The emerging health impact of voluntary medical male circumcision in Zimbabwe: An evaluation using three epidemiological models Public Library of Science 2018 VMMC program priority HIV prevention strategy UNAIDS coverage targets VMMC maintenance costs household survey data infection models Background Zimbabwe 2018-07-18 17:30:27 Dataset https://plos.figshare.com/articles/dataset/The_emerging_health_impact_of_voluntary_medical_male_circumcision_in_Zimbabwe_An_evaluation_using_three_epidemiological_models/6835685 <div><p>Background</p><p>Zimbabwe adopted voluntary medical male circumcision (VMMC) as a priority HIV prevention strategy in 2007 and began implementation in 2009. We evaluated the costs and impact of this VMMC program to date and in future.</p><p>Methods</p><p>Three mathematical models describing Zimbabwe’s HIV epidemic and program evolution were calibrated to household survey data on prevalence and risk behaviors, with circumcision coverage calibrated to program-reported VMMCs. We compared trends in new infections and costs to a counterfactual without VMMC. Input assumptions were agreed in workshops with national stakeholders in 2015 and 2017.</p><p>Results</p><p>The VMMC program averted 2,600–12,200 infections (among men and women combined) by the end of 2016. This impact will grow as circumcised men are protected lifelong, and onward dynamic transmission effects, which protect women via reduced incidence and prevalence in their male partners, increase over time. If other prevention interventions remain at 2016 coverages, the VMMCs already performed will avert 24,400–69,800 infections (2.3–5% of all new infections) through 2030. If coverage targets are achieved by 2021 and maintained, the program will avert 108,000–171,000 infections (10–13% of all new infections) by 2030, costing $2,100–3,250 per infection averted relative to no VMMC. Annual savings from averted treatment needs will outweigh VMMC maintenance costs once coverage targets are reached. If Zimbabwe also achieves ambitious UNAIDS targets for scaling up treatment and prevention efforts, VMMC will reduce the HIV incidence remaining at 2030 by one-third, critically contributing to the UNAIDS goal of 90% incidence reduction.</p><p>Conclusions</p><p>VMMC can substantially impact Zimbabwe’s HIV epidemic in the coming years; this investment will save costs in the longer term.</p></div>