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Age targeting and scale-up of voluntary medical male circumcision in Mozambique

Author

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  • Juan Dent
  • Nuno Gaspar
  • Emmanuel Njeuhmeli
  • Katharine Kripke

Abstract

Background: The voluntary medical male circumcision (VMMC) program in Mozambique aimed to increase male circumcision (MC) coverage to 80 percent among males ages 10 to 49 by 2018. Given the difficulty in attracting adult men over age 20 for circumcision, Mozambique became interested in assessing its age-targeting strategy and progress at the provincial level to inform program planning. Methods: We examined the impact and cost-effectiveness of circumcising different age groups of men using the Decision Makers’ Program Planning Toolkit, Version 2.1 (DMPPT 2). We also applied the model to assess the scale-up efforts through the end of September 2017 and project their impact on HIV incidence through 2030. The DMPPT 2 is a compartmental Excel-based model that analyzes the effects of age at circumcision on program impact and cost-effectiveness. The model tracks changes in age-specific MC coverage due to VMMC program circumcisions. Baseline MC prevalence was based on data from the 2011 Demographic and Health Survey. The DMPPT 2 was populated with HIV incidence projections from Spectrum/Goals under an assumption that Mozambique would reach its national targets for HIV treatment and prevention by 2022. Results: We estimate the VMMC program increased MC coverage among males ages 10 to 49 from 27 percent in 2009 to 48 percent by end of September 2017. Coverage increased primarily in males ages 10 to 29. VMMCs conducted in the national program through the end of September 2017 are projected to avert 67,076 HIV infections from 2010 to 2030. Scaling up circumcisions in males ages 20 to 29 will have the most immediate impact on HIV incidence, while the greatest impact over a 15-year period is obtained by circumcising males ages 15 to 24 in the majority of priority provinces. Circumcising 80 percent of males ages 10 to 29 can achieve 77 percent of the impact through 2030 compared with circumcising 80 percent of males ages 10 to 49. Conclusion: The VMMC program in Mozambique has made great strides in increasing MC coverage, particularly for males ages 10 to 29. Scaling up and maintaining MC coverage in this age group offers an attainable and cost-effective target for VMMC in Mozambique.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0211958
    DOI: 10.1371/journal.pone.0211958
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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. 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.
    4. Katharine Kripke & Andrea Vazzano & William Kirungi & Joshua Musinguzi & Alex Opio & Rhobbinah Ssempebwa & Susan Nakawunde & Sheila Kyobutungi & Juliet N Akao & Fred Magala & George Mwidu & Delivette , 2016. "Modeling the Impact of Uganda’s Safe Male Circumcision Program: Implications for Age and Regional Targeting," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-14, July.
    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. 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.
    7. 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.
    8. 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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