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

Author

Listed:
  • Susanne F Awad
  • Sema K Sgaier
  • Bushimbwa C Tambatamba
  • Yousra A Mohamoud
  • Fiona K Lau
  • Jason B Reed
  • Emmanuel Njeuhmeli
  • Laith J Abu-Raddad

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.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0145729
    DOI: 10.1371/journal.pone.0145729
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    References listed on IDEAS

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    1. 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.
    2. Fredrik Liljeros & Christofer R. Edling & Luís A. Nunes Amaral & H. Eugene Stanley & Yvonne Åberg, 2001. "The web of human sexual contacts," Nature, Nature, vol. 411(6840), pages 907-908, June.
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    1. 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.
    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.

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