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Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

Author

Listed:
  • Katharine Kripke
  • Karin Hatzold
  • Owen Mugurungi
  • Gertrude Ncube
  • Sinokuthemba Xaba
  • Elizabeth Gold
  • Kim Seifert Ahanda
  • Natalie Kruse-Levy
  • Emmanuel Njeuhmeli

Abstract

Background: Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20–29 was examined. Methods: Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10–19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20–29 with a corresponding increase in unit cost for these age groups. Results: When circumcision coverage among men ages 20–29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Conclusions: Although increased investment in recruiting VMMC clients ages 20–29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0164144
    DOI: 10.1371/journal.pone.0164144
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    References listed on IDEAS

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    1. Katharine Kripke & Nicole Perales & Jackson Lija & Bennet Fimbo & Eric Mlanga & Hally Mahler & James McOllogi Juma & Emmanuel Baingana & Marya Plotkin & Deogratias Kakiziba & Iris Semini & Delivette C, 2016. "The Economic and Epidemiological Impact of Focusing Voluntary Medical Male Circumcision for HIV Prevention on Specific Age Groups and Regions in Tanzania," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-14, July.
    2. Katharine Kripke & Velephi Okello & Vusi Maziya & Wendy Benzerga & Munamato Mirira & Elizabeth Gold & Melissa Schnure & Sema Sgaier & Delivette Castor & Jason Reed & Emmanuel Njeuhmeli, 2016. "Voluntary Medical Male Circumcision for HIV Prevention in Swaziland: Modeling the Impact of Age Targeting," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-10, July.
    3. Catherine Hankins & Mitchell Warren & Emmanuel Njeuhmeli, 2016. "Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-9, October.
    4. 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.
    5. 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.
    6. 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. 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. 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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