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Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014

BACKGROUND: In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progres...

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Autores principales: Kripke, Katharine, Njeuhmeli, Emmanuel, Samuelson, Julia, Schnure, Melissa, Dalal, Shona, Farley, Timothy, Hankins, Catherine, Thomas, Anne G., Reed, Jason, Stegman, Peter, Bock, Naomi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955652/
https://www.ncbi.nlm.nih.gov/pubmed/27441648
http://dx.doi.org/10.1371/journal.pone.0158767
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author Kripke, Katharine
Njeuhmeli, Emmanuel
Samuelson, Julia
Schnure, Melissa
Dalal, Shona
Farley, Timothy
Hankins, Catherine
Thomas, Anne G.
Reed, Jason
Stegman, Peter
Bock, Naomi
author_facet Kripke, Katharine
Njeuhmeli, Emmanuel
Samuelson, Julia
Schnure, Melissa
Dalal, Shona
Farley, Timothy
Hankins, Catherine
Thomas, Anne G.
Reed, Jason
Stegman, Peter
Bock, Naomi
author_sort Kripke, Katharine
collection PubMed
description BACKGROUND: In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. METHODS: Using the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets. RESULTS: More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. CONCLUSIONS: The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five-year age groups will inform countries’ decisions about next steps.
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spelling pubmed-49556522016-08-08 Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014 Kripke, Katharine Njeuhmeli, Emmanuel Samuelson, Julia Schnure, Melissa Dalal, Shona Farley, Timothy Hankins, Catherine Thomas, Anne G. Reed, Jason Stegman, Peter Bock, Naomi PLoS One Research Article BACKGROUND: In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. METHODS: Using the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets. RESULTS: More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. CONCLUSIONS: The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five-year age groups will inform countries’ decisions about next steps. Public Library of Science 2016-07-21 /pmc/articles/PMC4955652/ /pubmed/27441648 http://dx.doi.org/10.1371/journal.pone.0158767 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Kripke, Katharine
Njeuhmeli, Emmanuel
Samuelson, Julia
Schnure, Melissa
Dalal, Shona
Farley, Timothy
Hankins, Catherine
Thomas, Anne G.
Reed, Jason
Stegman, Peter
Bock, Naomi
Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014
title Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014
title_full Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014
title_fullStr Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014
title_full_unstemmed Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014
title_short Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014
title_sort assessing progress, impact, and next steps in rolling out voluntary medical male circumcision for hiv prevention in 14 priority countries in eastern and southern africa through 2014
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955652/
https://www.ncbi.nlm.nih.gov/pubmed/27441648
http://dx.doi.org/10.1371/journal.pone.0158767
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