July 19, 2018
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Medical male circumcision averts new HIV infections, saves costs in Zimbabwe

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Voluntary medical male circumcision may save costs in the long term and has already impacted the future of Zimbabwe’s HIV epidemic by averting new infections, according to a modeling study published in PLoS One.

Following a WHO recommendation made in 2007, more 14.5 million voluntary medical male circumcision (VMMC) procedures have been performed in countries with high HIV prevalence and low circumcision rates. Zimbabwe implemented the HIV prevention strategy in 2009, with 2021 target coverage levels set at 80% for men aged 15 to 29 years and 30% for boys aged 10 to 14 years, according to the study.

“By investing in VMMC to prevent HIV transmission now, Zimbabwe can save costs in the longer term, reducing the need for costly antiretroviral treatment in the future,” Eline L. Korenromp, PhD, senior modeler and advisor for Avenir Health in Geneva, Switzerland, told Infectious Diseases in Children. “According to our study, this is a highly cost-effective investment.”

To evaluate the cost-effectiveness and the ongoing and future health impacts of Zimbabwe’s VMMC program, Korenromp and colleagues used three mathematical models to describe Zimbabwe’s historical, ongoing and future HIV epidemic, as well as the evolution of its VMMC program. The models included data on the prevalence of disease and risk behaviors taken from household surveys, and circumcision coverage was based on program-reported VMMCs. The researchers compared tends in new infections and costs with a counterfactual scenario without the VMCC program, according to the study.

By the end of 2016, the VMMC program in Zimbabwe averted between 2,600 and 12,200 infections in both men and women, according to the study. The estimates by Korenromp and colleagues suggested that because men are protected lifelong, the impact will continue to grow. Additionally, reducing the incidence and prevalence of HIV among circumcised men will protect their women partners and, in the long term, the entire population of men and women against the disease, the they said. According to the study, the VMMCs already performed could avert between 24,400 to 69,800 infections (2.3% to 5% of all new infections) through 2030 if coverage levels of other prevention interventions remain as they were in 2016. If coverage targets set by the national program for 2021 are achieved and maintained after 2021, between 108,000 and 171,000 infections (10% to 13% of all new infections) would be averted by 2030.

Achieving this health impact through the VMMC program will cost between $2,100 and $3,250 per infection averted by 2030. However, once coverage targets are reached, VMMC maintenance costs will be outweighed by the annual savings from avoiding treatment needs, resulting in a net saving of anywhere between $55 and $198 million from overall HIV program costs from 2017 to 2030. Furthermore, VMMC may reduce the remaining HIV incidence by one-third in 2030 if Zimbabwe achieves targets set by the United Nations Program on HIV/AIDS for scaling up all other treatment and prevention efforts.

 “In a wider context of concerns about plateauing global resources for HIV/AIDS and mounting long-term costs of antiretroviral therapy programs, these are important findings to underpin continued high-priority investment in this uniquely cost-effective prevention intervention in Zimbabwe,” Jessica McGillen, DPhil, disease modeler at Imperial College London, said in a press release. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.