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Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when?

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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


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