title: Modeling the Impact of Uganda's Safe Male Circumcision Program: Implications for Age and Regional Targeting.
abstract: BACKGROUND
  Uganda aims to provide safe male circumcision (SMC) to 80% of men ages 15-49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program's progress, and to refine the implementation approach.
  
  
  RESULTS
  The Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0), was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM) to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20-34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10-19 will offer the greatest impact over a 15-year period, while focusing on men ages 15-34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed.
  
  
  CONCLUSIONS
  Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda's SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10-34 as a priority group for SMC in the 2014 application to the Global Fund's new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence.
authors.affiliation: Health Policy Project, Avenir Health, Washington, D.C., United States of America.
authors.forename: Katharine
authors.initials: K
authors.lastname: Kripke
authors.affiliation: Health Policy Project, Futures Group, Washington, D.C., United States of America.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vazzano
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: William
authors.initials: W
authors.lastname: Kirungi
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Joshua
authors.initials: J
authors.lastname: Musinguzi
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Opio
authors.affiliation: U.S. Agency for International Development (USAID), Kampala, Uganda.
authors.forename: Rhobbinah
authors.initials: R
authors.lastname: Ssempebwa
authors.affiliation: U.S. Agency for International Development (USAID), Kampala, Uganda.
authors.forename: Susan
authors.initials: S
authors.lastname: Nakawunde
authors.affiliation: U.S. Agency for International Development (USAID), Kampala, Uganda.
authors.forename: Sheila
authors.initials: S
authors.lastname: Kyobutungi
authors.affiliation: U.S. Department of Defense, Kampala, Uganda.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Akao
authors.affiliation: Makerere University Walter Reed Project, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Magala
authors.affiliation: Makerere University Walter Reed Project, Kampala, Uganda.
authors.forename: George
authors.initials: G
authors.lastname: Mwidu
authors.affiliation: USAID, Washington, D.C., United States of America.
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.affiliation: USAID, Washington, D.C., United States of America.
authors.forename: Emmanuel
authors.identifier: http://orcid.org/0000-0001-5370-4827
authors.initials: E
authors.lastname: Njeuhmeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005843:Geography; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult