The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved]
Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models we...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2021-01-01
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| Series: | Gates Open Research |
| Online Access: | https://gatesopenresearch.org/articles/5-15/v1 |
| _version_ | 1818948395044175872 |
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| author | Eline L. Korenromp Anna Bershteyn Edina Mudimu Renay Weiner Collen Bonecwe Dayanund Loykissoonlal Clarence Manuhwa Carel Pretorius Yu Teng John Stover Leigh F. Johnson |
| author_facet | Eline L. Korenromp Anna Bershteyn Edina Mudimu Renay Weiner Collen Bonecwe Dayanund Loykissoonlal Clarence Manuhwa Carel Pretorius Yu Teng John Stover Leigh F. Johnson |
| author_sort | Eline L. Korenromp |
| collection | DOAJ |
| description | Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years. |
| first_indexed | 2024-12-20T08:46:07Z |
| format | Article |
| id | doaj.art-afb96969a1384cc8b69ece5322b507bb |
| institution | Directory Open Access Journal |
| issn | 2572-4754 |
| language | English |
| last_indexed | 2024-12-20T08:46:07Z |
| publishDate | 2021-01-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | Gates Open Research |
| spelling | doaj.art-afb96969a1384cc8b69ece5322b507bb2022-12-21T19:46:15ZengF1000 Research LtdGates Open Research2572-47542021-01-01510.12688/gatesopenres.13220.114439The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved]Eline L. Korenromp0Anna Bershteyn1Edina Mudimu2Renay Weiner3Collen Bonecwe4Dayanund Loykissoonlal5Clarence Manuhwa6Carel Pretorius7Yu Teng8John Stover9Leigh F. Johnson10Center for Modeling and Analysis, Avenir Health, Geneva, SwitzerlandDepartment of Population and Health, NYU Langone Medical Center, New York, NY, 11016, USADepartment of Decision Sciences, University of South Africa (UNISA), Pretoria, 0003, South AfricaResearch and Training for Health and Development, Johannesburg, 2196, South AfricaNational Department of Health, Pretoria, South AfricaNational Department of Health, Pretoria, South AfricaFHI 360, Pretoria, 0083, South AfricaCenter for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USACenter for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USACenter for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USACentre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South AfricaBackground: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.https://gatesopenresearch.org/articles/5-15/v1 |
| spellingShingle | Eline L. Korenromp Anna Bershteyn Edina Mudimu Renay Weiner Collen Bonecwe Dayanund Loykissoonlal Clarence Manuhwa Carel Pretorius Yu Teng John Stover Leigh F. Johnson The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved] Gates Open Research |
| title | The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved] |
| title_full | The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved] |
| title_fullStr | The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved] |
| title_full_unstemmed | The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved] |
| title_short | The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models [version 1; peer review: 2 approved] |
| title_sort | impact of the program for medical male circumcision on hiv in south africa analysis using three epidemiological models version 1 peer review 2 approved |
| url | https://gatesopenresearch.org/articles/5-15/v1 |
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