title: Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014.
abstract: BACKGROUND
  In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress.
  
  
  METHODS
  Using the Decision Makers' Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15-49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS' 90-90-90 treatment targets.
  
  
  RESULTS
  More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15-24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds.
  
  
  CONCLUSIONS
  The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five-year age groups will inform countries' decisions about next steps.
authors.affiliation: Project SOAR (Supporting Operational AIDS Research), Avenir Health, Washington, District of Columbia, United States of America.
authors.forename: Katharine
authors.initials: K
authors.lastname: Kripke
authors.affiliation: U.S. Agency for International Development, Washington, District of Columbia, United States of America.
authors.forename: Emmanuel
authors.identifier: http://orcid.org/0000-0001-5370-4827
authors.initials: E
authors.lastname: Njeuhmeli
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Samuelson
authors.affiliation: Project SOAR, Palladium Group, Washington, District of Columbia, United States of America.
authors.forename: Melissa
authors.initials: M
authors.lastname: Schnure
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Shona
authors.initials: S
authors.lastname: Dalal
authors.affiliation: Sigma3 Services, Nyon, Switzerland.
authors.forename: Timothy
authors.initials: T
authors.lastname: Farley
authors.affiliation: Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hankins
authors.affiliation: Naval Health Research Center, US Department of Defense, San Diego, California, United States of America.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Thomas
authors.affiliation: Jhpiego, Washington, District of Columbia, United States of America.
authors.forename: Jason
authors.initials: J
authors.lastname: Reed
authors.affiliation: Project SOAR (Supporting Operational AIDS Research), Avenir Health, Washington, District of Columbia, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Stegman
authors.affiliation: U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Naomi
authors.initials: N
authors.lastname: Bock
mesh_terms: D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000353:Africa, Southern / Q000453:epidemiology; D017677:Age Distribution; D002944:Circumcision, Male / Q000191:economics / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis / Q000191:economics*; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D035141:Voluntary Programs; D055815:Young Adult