oa Generic Results For The Effective+B168Ness Of Medical Male Circumcision As An Hiv Intervention In Sub-Saharan Africa

Background: The efficacy of medical male circumcision (MMC) in reducing female to male HIV transmission has been established by three clinical trials. Programs are being developed for massive roll-out of MMC as an HIV intervention across multiple countries in sub-Saharan Africa (SSA). We aimed in this study to explore generic results of the effectiveness of MMC as an HIV intervention. Method: A population-level deterministic model was constructed to describe a prototype heterosexual HIV epidemic in SSA. The model consists of a set of coupled nonlinear differential equations that stratifies the population into compartments according to sex, circumcision status, age group, sexual risk group, and HIV status and stage of infection. The model was parameterized by state of the art empirical data of HIV natural history and transmission. Sensitivity analyses with respect to different effects were conducted. Results: The effectiveness of MMC, defined as the number of MMCs needed to avert one HIV infection, was inversely proportional to HIV prevalence with as little as about 10 MMCs needed for each infection averted in settings at high HIV prevalence. The effectiveness also varied substantially with each of the 5-years age groups targeted, with the highest effectiveness found by targeting the 20-24 years age group. Risk targeting strongly affected the estimated effectiveness. MMC effectiveness was an order of magnitude higher by targeting the high-risk groups as opposed to the general population. The speed of scale-up influenced also the estimated effectiveness in the short-term, but was less influential for long-term time horizons. MMC was found to be generally cost-effective, with the cost per infection averted being less than $1000 for most settings. Conclusion: Our findings demonstrate that MMC is an effective HIV prevention intervention, and likely to be cost-effective in most settings in SSA. The highest MMC effectiveness is attained by targeting young sexually active males and high-risk groups. These generic results of MMC effectiveness suggest the need for custom-designed assessments for each country separately, taking into account the likely temporal evolution of the epidemic in the next few decades, the age and geographic distribution of HIV infection, population pyramid, and the country-specific cost for each MMC performed.