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Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces

Author

Listed:
  • Katharine Kripke
  • Ping-An Chen
  • Andrea Vazzano
  • Ananthy Thambinayagam
  • Yogan Pillay
  • Dayanund Loykissoonlal
  • Collen Bonnecwe
  • Peter Barron
  • Eva Kiwango
  • Delivette Castor
  • Emmanuel Njeuhmeli

Abstract

Background: In 2012, South Africa set a goal of circumcising 4.3 million men ages 15–49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC). In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographic locations would be particularly impactful or cost-effective. Results will inform South Africa’s efforts to develop a national strategy and operational plan for VMMC. Methods and Findings: The study team populated the Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0) with HIV incidence projections from the Spectrum/AIDS Impact Module (AIM), as well as national and provincial population and HIV prevalence estimates. We derived baseline circumcision rates from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The model showed that circumcising men ages 20–34 offers the most immediate impact on HIV incidence and requires the fewest circumcisions per HIV infection averted. The greatest impact over a 15-year period is achieved by circumcising men ages 15–24. When the model assumes a unit cost increase with client age, men ages 15–29 emerge as the most cost-effective group. When we assume a constant cost for all ages, the most cost-effective age range is 15–34 years. Geographically, the program is cost saving in all provinces; differences in the VMMC program’s cost-effectiveness across provinces were obscured by uncertainty in HIV incidence projections. Conclusion: The VMMC program’s impact and cost-effectiveness vary by age-targeting strategy. A strategy focusing on men ages 15–34 will maximize program benefits. However, because clients older than 25 access VMMC services at low rates, South Africa could consider promoting demand among men ages 25–34, without denying services to those in other age groups. Uncertainty in the provincial estimates makes them insufficient to support geographic targeting.

Suggested Citation

  • Katharine Kripke & Ping-An Chen & Andrea Vazzano & Ananthy Thambinayagam & Yogan Pillay & Dayanund Loykissoonlal & Collen Bonnecwe & Peter Barron & Eva Kiwango & Delivette Castor & Emmanuel Njeuhmeli, 2016. "Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-13, July.
  • Handle: RePEc:plo:pone00:0157071
    DOI: 10.1371/journal.pone.0157071
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    References listed on IDEAS

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    1. Katharine Kripke & Marjorie Opuni & Melissa Schnure & Sema Sgaier & Delivette Castor & Jason Reed & Emmanuel Njeuhmeli & John Stover, 2016. "Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-17, July.
    2. Michel Tchuenche & Eurica Palmer & Vibhuti Haté & Ananthy Thambinayagam & Dayanund Loykissoonlal & Emmanuel Njeuhmeli & Steven Forsythe, 2016. "The Cost of Voluntary Medical Male Circumcision in South Africa," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-17, October.
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    1. Katharine Kripke & Marjorie Opuni & Melissa Schnure & Sema Sgaier & Delivette Castor & Jason Reed & Emmanuel Njeuhmeli & John Stover, 2016. "Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-17, July.
    2. Thabang Manyaapelo & Anam Nyembezi & Robert A. C. Ruiter & Bart Van den Borne & Sibusiso Sifunda & Priscilla Reddy, 2017. "Understanding the Psychosocial Correlates of the Intention to Use Condoms among Young Men in KwaZulu-Natal, South Africa," IJERPH, MDPI, vol. 14(4), pages 1-15, March.
    3. Juan Dent & Nuno Gaspar & Emmanuel Njeuhmeli & Katharine Kripke, 2019. "Age targeting and scale-up of voluntary medical male circumcision in Mozambique," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-14, February.

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