title: Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa.
abstract: BACKGROUND
  There is strong evidence showing that voluntary medical male circumcision (VMMC) reduces HIV incidence in men. To inform the VMMC policies and goals of 13 priority countries in eastern and southern Africa, we estimate the impact and cost of scaling up adult VMMC using updated, country-specific data.
  
  
  RESULTS
  We use the Decision Makers' Program Planning Tool (DMPPT) to model the impact and cost of scaling up adult VMMC in Botswana, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, and Nyanza Province in Kenya. We use epidemiologic and demographic data from recent household surveys for each country. The cost of VMMC ranges from US$65.85 to US$95.15 per VMMC performed, based on a cost assessment of VMMC services aligned with the World Health Organization's considerations of models for optimizing volume and efficiencies. Results from the DMPPT models suggest that scaling up adult VMMC to reach 80% coverage in the 13 countries by 2015 would entail performing 20.34 million circumcisions between 2011 and 2015 and an additional 8.42 million between 2016 and 2025 (to maintain the 80% coverage). Such a scale-up would result in averting 3.36 million new HIV infections through 2025. In addition, while the model shows that this scale-up would cost a total of US$2 billion between 2011 and 2025, it would result in net savings (due to averted treatment and care costs) amounting to US$16.51 billion.
  
  
  CONCLUSIONS
  This study suggests that rapid scale-up of VMMC in eastern and southern Africa is warranted based on the likely impact on the region's HIV epidemics and net savings. Scaling up of safe VMMC in eastern and southern Africa will lead to a substantial reduction in HIV infections in the countries and lower health system costs through averted HIV care costs.
authors.affiliation: United States Agency for International Development, Washington, District of Columbia, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.forename: Steven
authors.initials: S
authors.lastname: Forsythe
authors.forename: Jason
authors.initials: J
authors.lastname: Reed
authors.forename: Marjorie
authors.initials: M
authors.lastname: Opuni
authors.forename: Lori
authors.initials: L
authors.lastname: Bollinger
authors.forename: Nathan
authors.initials: N
authors.lastname: Heard
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.forename: John
authors.initials: J
authors.lastname: Stover
authors.forename: Timothy
authors.initials: T
authors.lastname: Farley
authors.forename: Veena
authors.initials: V
authors.lastname: Menon
authors.forename: Catherine
authors.initials: C
authors.lastname: Hankins
mesh_terms: D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D002944:Circumcision, Male / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics* / Q000458:organization & administration; D012725:Sexual Behavior / Q000523:psychology; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult