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A Reevaluation of the Voluntary Medical Male Circumcision Scale-Up Plan in Zimbabwe

Author

Listed:
  • Susanne F Awad
  • Sema K Sgaier
  • Gertrude Ncube
  • Sinokuthemba Xaba
  • Owen M Mugurungi
  • Mutsa M Mhangara
  • Fiona K Lau
  • Yousra A Mohamoud
  • Laith J Abu-Raddad

Abstract

Background: The voluntary medical male circumcision (VMMC) program in Zimbabwe aims to circumcise 80% of males aged 13–29 by 2017. We assessed the impact of actual VMMC scale-up to date and evaluated the impact of potential alterations to the program to enhance program efficiency, through prioritization of subpopulations. Methods and Findings: We implemented a recently developed analytical approach: the age-structured mathematical (ASM) model and accompanying three-level conceptual framework to assess the impact of VMMC as an intervention. By September 2014, 364,185 males were circumcised, an initiative that is estimated to avert 40,301 HIV infections by 2025. Through age-group prioritization, the number of VMMCs needed to avert one infection (effectiveness) ranged between ten (20–24 age-group) and 53 (45–49 age-group). The cost per infection averted ranged between $811 (20–24 age-group) and $5,518 (45–49 age-group). By 2025, the largest reductions in HIV incidence rate (up to 27%) were achieved by prioritizing 10–14, 15–19, or 20–24 year old. The greatest program efficiency was achieved by prioritizing 15–24, 15–29, or 15–34 year old. Prioritizing males 13–29 year old was programmatically efficient, but slightly inferior to the 15–24, 15–29, or 15–34 age groups. Through geographic prioritization, effectiveness varied from 9–12 VMMCs per infection averted across provinces. Through risk-group prioritization, effectiveness ranged from one (highest sexual risk-group) to 60 (lowest sexual risk-group) VMMCs per infection averted. Conclusion: The current VMMC program plan in Zimbabwe is targeting an efficient and impactful age bracket (13–29 year old), but program efficiency can be improved by prioritizing a subset of males for demand creation and service availability. The greatest program efficiency can be attained by prioritizing young sexually active males and males whose sexual behavior puts them at higher risk for acquiring HIV.

Suggested Citation

  • Susanne F Awad & Sema K Sgaier & Gertrude Ncube & Sinokuthemba Xaba & Owen M Mugurungi & Mutsa M Mhangara & Fiona K Lau & Yousra A Mohamoud & Laith J Abu-Raddad, 2015. "A Reevaluation of the Voluntary Medical Male Circumcision Scale-Up Plan in Zimbabwe," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-16, November.
    • Handle: RePEc:plo:pone00:0140818
    DOI: 10.1371/journal.pone.0140818
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    1. Susanne F Awad & Sema K Sgaier & Bushimbwa C Tambatamba & Yousra A Mohamoud & Fiona K Lau & Jason B Reed & Emmanuel Njeuhmeli & Laith J Abu-Raddad, 2015. "Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-25, December.
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    Cited by:

    1. Jessica B McGillen & John Stover & Daniel J Klein & Sinokuthemba Xaba & Getrude Ncube & Mutsa Mhangara & Geraldine N Chipendo & Isaac Taramusi & Leo Beacroft & Timothy B Hallett & Patrick Odawo & Rumb, 2018. "The emerging health impact of voluntary medical male circumcision in Zimbabwe: An evaluation using three epidemiological models," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-17, July.
    2. Katharine Kripke & Karin Hatzold & Owen Mugurungi & Gertrude Ncube & Sinokuthemba Xaba & Elizabeth Gold & Kim Seifert Ahanda & Natalie Kruse-Levy & Emmanuel Njeuhmeli, 2016. "Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-16, October.
    3. Katharine Kripke & Frank Chimbwandira & Zebedee Mwandi & Faustin Matchere & Melissa Schnure & Jason Reed & Delivette Castor & Sema Sgaier & Emmanuel Njeuhmeli, 2016. "Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-11, July.
    4. Susanne F Awad & Sema K Sgaier & Bushimbwa C Tambatamba & Yousra A Mohamoud & Fiona K Lau & Jason B Reed & Emmanuel Njeuhmeli & Laith J Abu-Raddad, 2015. "Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-25, December.

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    1. Katharine Kripke & Frank Chimbwandira & Zebedee Mwandi & Faustin Matchere & Melissa Schnure & Jason Reed & Delivette Castor & Sema Sgaier & Emmanuel Njeuhmeli, 2016. "Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-11, July.
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