Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when?

RG White, JR Glynn, KK Orroth, EE Freeman, Roel Bakker, HA Weiss, L Kumaranayake, Dik Habbema, A Buve, RJ Hayes

Research output: Contribution to journalArticleAcademicpeer-review

73 Citations (Scopus)

Abstract

Background and objective: Male circumcision (circumcision) reduces HIV incidence in men by 50-60%. The United Nations Joint Programme on HIV/AIDS (UNAIDS) recommends the provision of safe circumcision services in countries with high HIV and low circumcision prevalence, prioritizing 12-30 years old HIV-uninfected men. We explore how the population-level impact of circumcision varies by target age group, coverage, time-to-scale-up, level of risk compensation and circumcision of HIV-infected men. Design and methods: An individual-based model was fitted to the characteristics of a typical high-HIV-prevalence population in sub-Saharan Africa and three scenarios of individual-level impact corresponding to the central and the 95% confidence level estimates from the Kenyan circumcision trial. The simulated intervention increased the prevalence of circumcision from 25 to 75%. over 5 years in targeted age groups. The impact and cost-effectiveness of the intervention were calculated over 2-50 years. Future costs and effects were discounted and compared with the present value of lifetime HIV treatment costs (US$ 4043). Results: Initially, targeting men older than the United Nations Joint Programme on HIV/AIDS recommended age group may be the most cost-effective strategy, but targeting any adult age group will be cost-saving. Substantial risk compensation Could negate impact, particularly if already circumcised men compensate. If circumcision prevalence in HIVuninfected men increases less because HIV-infected men are also circumcised, this will reduce impact in men but would have little effect on population-level impact in women. Conclusion: Circumcision is a cost-saving intervention in a wide range of scenarios of HIV and initial circumcision prevalence but the United Nations Joint Programme on HIV/AIDS/WHO recommended target age group should be widened to include older HIV-uninfected men and counselling should be targeted at both newly and already circumcised men to minimize risk compensation. To maximize infections-averted, circumcision Must be scaled up rapidly while maintaining quality. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Original languageUndefined/Unknown
Pages (from-to)1841-1850
Number of pages10
JournalAIDS
Volume22
Issue number14
DOIs
Publication statusPublished - 2008

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