Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Awad, Susanne F. ; Sgaier, Sema K. ; Lau, Fiona K. ; Mohamoud, Yousra A. ; Tambatamba, Bushimbwa C. ; Kripke, Katharine E. ; Thomas, Anne G. ; Bock, Naomi ; Reed, Jason B. ; Njeuhmeli, Emmanuel ; Abu-Raddad, Laith J.
• Description:
  Background
  
  The epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example.
  
  Methods and Findings
  
  We used the Age-Structured Mathematical (ASM) model to evaluate, over an intermediate horizon (2010–2025), the effectiveness (number of VMMCs needed to avert one HIV infection) of VMMC scale-up scenarios with varying proportions of HIV-positive males. The model was calibrated by fitting to HIV prevalence time trend data from 1990 to 2014. We assumed that inclusivity of HIV positive males may benefit VMMC programs by increasing VMMC uptake among higher risk males, or by circumcision reducing HIV male-to-female transmission risk. All analyses were generated assuming no further antiretroviral therapy (ART) scale-up.
  
  Conclusion
  
  Improving inclusivity of males in VMMC programs regardless of HIV status increases VMMC effectiveness, if there is moderate increase in VMMC uptake among higher-risk males and/or if there is moderate efficacy for VMMC against male-to-female transmission. In these circumstances, VMMC programs can reduce the HIV incidence rate in males by nearly as much as expected by some ART programs, and additionally, females can benefit from the intervention nearly as much as males.
  
  
• Subjects:
  Adolescent Adult Age Factors Circumcision, Male Epidemics Female Health Policy Health Promotion HIV Infections HIV Seropositivity HIV Seroprevalence Humans Incidence Male Middle Aged Models, Theoretical Patient Acceptance Of Health Care Program Evaluation Sexual Behavior Uncertainty Young Adult

  More +
• Source:
  PLoS One. 12(1).
• Pubmed ID:
  28118387
• Pubmed Central ID:
  PMC5261810
• Document Type:
  Journal Article
• Place as Subject:
  Zambia
• Volume:
  12
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:da403f5e881bc5967c2efe39bccc5cd178351fa1cb922627eec70c68af440eda
• Download URL:
  https://stacks.cdc.gov/view/cdc/46196/cdc_46196_DS1.pdf
• File Type:
  [PDF - 2.26 MB ]