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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

Sensitivity analyses on predictions of intervention outcomes.A) Sensitivity of model-predicted intervention effectiveness to antiretroviral therapy (ART) coverage scale-up over the coming decades. The sensitivity analysis compares effectiveness with and without mass ART scale-up for different age-group prioritizations. B) Sensitivity of model-predicted intervention effectiveness to sexual risk compensation with VMMC. The sensitivity analysis is conducted by comparing the effectiveness at six different levels of risk compensation, starting with 0% risk compensation, by targeting the 15–49 age bracket.
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pone.0145729.g006: Sensitivity analyses on predictions of intervention outcomes.A) Sensitivity of model-predicted intervention effectiveness to antiretroviral therapy (ART) coverage scale-up over the coming decades. The sensitivity analysis compares effectiveness with and without mass ART scale-up for different age-group prioritizations. B) Sensitivity of model-predicted intervention effectiveness to sexual risk compensation with VMMC. The sensitivity analysis is conducted by comparing the effectiveness at six different levels of risk compensation, starting with 0% risk compensation, by targeting the 15–49 age bracket.

Mentions: Fig 6 presents the results of the different conducted sensitivity analyses. Overall, with mass ART scale-up about twice as many VMMCs were needed to avert one HIV infection than without mass ART scale-up (Fig 6A). For instance, the number of VMMCs required by targeting the 20–24 year age group increased from 11 VMMCs per infection averted in the absence of mass ART scale-up to 18 VMMCs per infection averted in the presence of mass ART scale-up. The effectiveness of VMMC was also reduced with risk compensation (Fig 6B). The number of VMMCs needed to avert one infection was almost twice as high if we assume 25% risk compensation, in comparison with the intervention scenario, where no risk compensation was assumed.


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)

Sensitivity analyses on predictions of intervention outcomes.A) Sensitivity of model-predicted intervention effectiveness to antiretroviral therapy (ART) coverage scale-up over the coming decades. The sensitivity analysis compares effectiveness with and without mass ART scale-up for different age-group prioritizations. B) Sensitivity of model-predicted intervention effectiveness to sexual risk compensation with VMMC. The sensitivity analysis is conducted by comparing the effectiveness at six different levels of risk compensation, starting with 0% risk compensation, by targeting the 15–49 age bracket.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0145729.g006: Sensitivity analyses on predictions of intervention outcomes.A) Sensitivity of model-predicted intervention effectiveness to antiretroviral therapy (ART) coverage scale-up over the coming decades. The sensitivity analysis compares effectiveness with and without mass ART scale-up for different age-group prioritizations. B) Sensitivity of model-predicted intervention effectiveness to sexual risk compensation with VMMC. The sensitivity analysis is conducted by comparing the effectiveness at six different levels of risk compensation, starting with 0% risk compensation, by targeting the 15–49 age bracket.
Mentions: Fig 6 presents the results of the different conducted sensitivity analyses. Overall, with mass ART scale-up about twice as many VMMCs were needed to avert one HIV infection than without mass ART scale-up (Fig 6A). For instance, the number of VMMCs required by targeting the 20–24 year age group increased from 11 VMMCs per infection averted in the absence of mass ART scale-up to 18 VMMCs per infection averted in the presence of mass ART scale-up. The effectiveness of VMMC was also reduced with risk compensation (Fig 6B). The number of VMMCs needed to avert one infection was almost twice as high if we assume 25% risk compensation, in comparison with the intervention scenario, where no risk compensation was assumed.

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