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>