title: Financial implications of male circumcision scale-up for the prevention of HIV and other sexually transmitted infections in a sub-Saharan African community.
abstract: BACKGROUND
  The financial implications of male circumcision (MC) scale-up in sub-Saharan Africa associated with reduced HIV have been evaluated. However, no analysis has incorporated the expected reduction of a comprehensive set of other sexually transmitted infections including human papillomavirus, herpes simplex virus type 2, genital ulcer disease, bacterial vaginosis, and trichomoniasis.
  
  
  METHODS
  A Markov model tracked a dynamic population undergoing potential MC scale-up, as individuals experienced MC procedures, procedure-related adverse events, and MC-reduced sexually transmitted infections and accrued any associated costs. Rakai, Uganda, was used as a prototypical rural sub-Saharan African community. Monte Carlo microsimulations evaluated outcomes under 4 alternative scale-up strategies to reach 80% MC coverage among men aged 15 to 49 years, in addition to a baseline strategy defined by current MC rates in central Uganda. Financial outcomes included direct medical expenses only and were evaluated over 5 and 25 years. Costs were discounted to the beginning of each period, coinciding with the start of MC scale-up, and expressed in US $2012.
  
  
  RESULTS
  Cost savings from infections averted by MC vary from US $197,531 after 5 years of a scale-up program focusing on adolescent/adult procedures to more than US $13 million after 25 years, under a strategy incorporating increased infant MCs. Over a 5-year period, reduction in HIV contributes to 50% of cost savings, and for 25 years, this contribution rises to nearly 90%.
  
  
  CONCLUSIONS
  Sexually transmitted infections other than HIV contribute to cost savings associated with MC scale-up. Previous analyses, focusing exclusively on the financial impact through averted HIV, may have underestimated true cost savings by 10% to 50%.
authors: Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
authors: Seema
authors: S
authors: Kacker
authors: Kevin D
authors: KD
authors: Frick
authors: Thomas C
authors: TC
authors: Quinn
authors: Ronald H
authors: RH
authors: Gray
authors: Aaron A R
authors: AA
authors: Tobian
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005832:Genital Diseases, Male / Q000191:economics* / Q000517:prevention & control; D006558:Herpes Genitalis / Q000191:economics* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D030361:Papillomavirus Infections / Q000191:economics* / Q000517:prevention & control; D012749:Sexually Transmitted Diseases / Q000191:economics* / Q000517:prevention & control; D014245:Trichomonas Infections / Q000191:economics* / Q000517:prevention & control; D014454:Uganda; D016585:Vaginosis, Bacterial / Q000191:economics* / Q000517:prevention & control; D055815:Young Adult
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