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Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia.

Awad SF, Sgaier SK, Tambatamba BC, Mohamoud YA, Lau FK, Reed JB, Njeuhmeli E, Abu-Raddad LJ - PLoS ONE (2015)

Bottom Line: Through geographic prioritization, effectiveness ranged from 9-12.Prioritizing Lusaka achieved the highest effectiveness.Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.

ABSTRACT

Background: Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia.

Methods and findings: A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15-49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20-24 age-group) to 36 (45-49 age-group); cost-effectiveness ranged from $888 (20-24 age-group) to $3,300 (45-49 age-group). Circumcising 10-14, 15-19, or 20-24 year old achieved the largest incidence rate reduction; prioritizing 15-24, 15-29, or 15-34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9-12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs.

Conclusion: Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.

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Related in: MedlinePlus

Feasibility and time required to achieve 1.95 million voluntary medical male circumcisions (VMMCs) among 15–49 year old males through two forecast scenarios.The cumulative number of VMMCs for two different projections based on the current roll-out of the VMMC program (forecast plan based on no-growth scale-up scenario and forecast plan based on current VMMC program scale-up scenario). These projections are compared to the original Zambia VMMC program scale-up plan.
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pone.0145729.g002: Feasibility and time required to achieve 1.95 million voluntary medical male circumcisions (VMMCs) among 15–49 year old males through two forecast scenarios.The cumulative number of VMMCs for two different projections based on the current roll-out of the VMMC program (forecast plan based on no-growth scale-up scenario and forecast plan based on current VMMC program scale-up scenario). These projections are compared to the original Zambia VMMC program scale-up plan.

Mentions: Fig 2 and S3 Table explore the feasibility of achieving 1.95 million VMMCs among 15–49 year old males by 2015 through the two forecast scenarios. Each scenario was compared to the original Zambia VMMC program scale-up plan [47] (S3 Table). The forecast plan based on current actual VMMC program scale-up achieved 1.37 million VMMCs by 2015. The predicted number of VMMCs was lower in the forecast plan based on the no-growth scenario (1.21 million). Accordingly, by the year 2015, the two forecast scenarios would have achieved only 62% to 70% of the original Zambia VMMC scale-up plan’s target of 1.95 million VMMCs, and only 61% of implemented VMMCs would actually be among 15–49 year old males [4, 47]. In these forecast scenarios, the VMMC program would have achieved only 25% to 30% VMMC coverage among the 15–49 year old males by 2015. The two forecast scenarios would reach the goal of 1.95 million VMMCs only if the VMMC plans continue implementing circumcisions for two to three more years.


Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia.

Awad SF, Sgaier SK, Tambatamba BC, Mohamoud YA, Lau FK, Reed JB, Njeuhmeli E, Abu-Raddad LJ - PLoS ONE (2015)

Feasibility and time required to achieve 1.95 million voluntary medical male circumcisions (VMMCs) among 15–49 year old males through two forecast scenarios.The cumulative number of VMMCs for two different projections based on the current roll-out of the VMMC program (forecast plan based on no-growth scale-up scenario and forecast plan based on current VMMC program scale-up scenario). These projections are compared to the original Zambia VMMC program scale-up plan.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696770&req=5

pone.0145729.g002: Feasibility and time required to achieve 1.95 million voluntary medical male circumcisions (VMMCs) among 15–49 year old males through two forecast scenarios.The cumulative number of VMMCs for two different projections based on the current roll-out of the VMMC program (forecast plan based on no-growth scale-up scenario and forecast plan based on current VMMC program scale-up scenario). These projections are compared to the original Zambia VMMC program scale-up plan.
Mentions: Fig 2 and S3 Table explore the feasibility of achieving 1.95 million VMMCs among 15–49 year old males by 2015 through the two forecast scenarios. Each scenario was compared to the original Zambia VMMC program scale-up plan [47] (S3 Table). The forecast plan based on current actual VMMC program scale-up achieved 1.37 million VMMCs by 2015. The predicted number of VMMCs was lower in the forecast plan based on the no-growth scenario (1.21 million). Accordingly, by the year 2015, the two forecast scenarios would have achieved only 62% to 70% of the original Zambia VMMC scale-up plan’s target of 1.95 million VMMCs, and only 61% of implemented VMMCs would actually be among 15–49 year old males [4, 47]. In these forecast scenarios, the VMMC program would have achieved only 25% to 30% VMMC coverage among the 15–49 year old males by 2015. The two forecast scenarios would reach the goal of 1.95 million VMMCs only if the VMMC plans continue implementing circumcisions for two to three more years.

Bottom Line: Through geographic prioritization, effectiveness ranged from 9-12.Prioritizing Lusaka achieved the highest effectiveness.Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.

ABSTRACT

Background: Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia.

Methods and findings: A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15-49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20-24 age-group) to 36 (45-49 age-group); cost-effectiveness ranged from $888 (20-24 age-group) to $3,300 (45-49 age-group). Circumcising 10-14, 15-19, or 20-24 year old achieved the largest incidence rate reduction; prioritizing 15-24, 15-29, or 15-34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9-12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs.

Conclusion: Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.

Show MeSH
Related in: MedlinePlus