dc.contributor.author |
White, R. G. |
|
dc.contributor.author |
Glynn, J. R. |
|
dc.contributor.author |
Orroth, K. K. |
|
dc.contributor.author |
Freeman, E. E. |
|
dc.contributor.author |
Bakker, R. |
|
dc.contributor.author |
Weiss, H. A. |
|
dc.contributor.author |
Kumaranayake, L. |
|
dc.contributor.author |
Habbema, J. D. F. |
|
dc.contributor.author |
Buvé, A. |
|
dc.contributor.author |
Hayes, R. J. |
|
dc.date.accessioned |
2008-10-29T12:59:42Z |
|
dc.date.available |
2008-10-29T12:59:42Z |
|
dc.date.issued |
2008 |
|
dc.identifier.issn |
0269-9370 |
|
dc.identifier.doi |
http://dx.doi.org/10.1097/QAD.0b013e32830e0137 |
|
dc.identifier.other |
ITG-M9A |
|
dc.identifier.other |
MICRO |
|
dc.identifier.other |
U-HIVSTD |
|
dc.identifier.other |
JIF |
|
dc.identifier.other |
DOI |
|
dc.identifier.other |
ABSTRACT |
|
dc.identifier.other |
UPD7 |
|
dc.identifier.uri |
http://hdl.handle.net/10390/2424 |
|
dc.description |
Not the final published version |
|
dc.description.abstract |
BACKGROUND AND OBJECTIVE: Male circumcision (circumcision) reduces HIV incidence in men by 50-60%. The United Nations Joint Programme on HIV/AIDS (UNAIDS) recommends the provision of safe circumcision services in countries with high HIV and low circumcision prevalence, prioritizing 12-30 years old HIV-uninfected men. We explore how the population-level impact of circumcision varies by target age group, coverage, time-to-scale-up, level of risk compensation and circumcision of HIV infected men. DESIGN AND METHODS: An individual-based model was fitted to the characteristics of a typical high-HIV-prevalence population in sub-Saharan Africa and three scenarios of individual-level impact corresponding to the central and the 95% confidence level estimates from the Kenyan circumcision trial. The simulated intervention increased the prevalence of circumcision from 25 to 75% over 5 years in targeted age groups. The impact and cost-effectiveness of the intervention were calculated over 2-50 years. Future costs and effects were discounted and compared with the present value of lifetime HIV treatment costs (US$ 4043). RESULTS: Initially, targeting men older than the United Nations Joint Programme on HIV/AIDS recommended age group may be the most cost-effective strategy, but targeting any adult age group will be cost-saving. Substantial risk compensation could negate impact, particularly if already circumcised men compensate. If circumcision prevalence in HIV uninfected men increases less because HIV-infected men are also circumcised, this will reduce impact in men but would have little effect on population-level impact in women. CONCLUSION: Circumcision is a cost-saving intervention in a wide range of scenarios of HIV and initial circumcision prevalence but the United Nations Joint Programme on HIV/AIDS/WHO recommended target age group should be widened to include older HIV-uninfected men and counselling should be targeted at both newly and already circumcised men to minimize risk compensation. To maximize infections-averted, circumcision must be scaled up rapidly while maintaining quality. |
en_US |
dc.language |
English |
en_US |
dc.publisher |
Lippincott, Williams & Wilkins |
|
dc.subject |
Viral diseases |
en_US |
dc.subject |
HIV |
en_US |
dc.subject |
AIDS |
en_US |
dc.subject |
Prevention strategies |
en_US |
dc.subject |
Male circumcision |
en_US |
dc.subject |
Cost-effectiveness |
en_US |
dc.subject |
Sexually transmitted diseases |
en_US |
dc.subject |
Primary prevention |
en_US |
dc.subject |
Targeted approach |
en_US |
dc.subject |
Age |
en_US |
dc.subject |
Risk compensation |
en_US |
dc.subject |
Africa, General |
en_US |
dc.title |
Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when? |
en_US |
dc.type |
Article |
en_US |
dc.citation.issue |
14 |
en_US |
dc.citation.jtitle |
AIDS |
en_US |
dc.citation.volume |
22 |
en_US |
dc.citation.pages |
1841-1850 |
en_US |
dc.publisher.place |
Philadelphia |
|
dc.identifier.pmid |
http://www.ncbi.nlm.nih.gov/pubmed/18753931 |
|
dc.citation.jabbreviation |
AIDS |
en_US |