Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia
Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determi...
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| description | Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia.
A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15-49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20-24 age-group) to 36 (45-49 age-group); cost-effectiveness ranged from $888 (20-24 age-group) to $3,300 (45-49 age-group). Circumcising 10-14, 15-19, or 20-24 year old achieved the largest incidence rate reduction; prioritizing 15-24, 15-29, or 15-34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9-12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs.
Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups. |
| doi_str_mv | 10.1371/journal.pone.0145729 |
| format | Article |
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A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15-49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20-24 age-group) to 36 (45-49 age-group); cost-effectiveness ranged from $888 (20-24 age-group) to $3,300 (45-49 age-group). Circumcising 10-14, 15-19, or 20-24 year old achieved the largest incidence rate reduction; prioritizing 15-24, 15-29, or 15-34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9-12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs.
Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0145729</identifier><identifier>PMID: 26716442</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; Age ; AIDS ; Antiretroviral drugs ; Child ; Circumcision ; Circumcision, Male - economics ; Cost analysis ; Cost-Benefit Analysis - economics ; Development and progression ; Disease prevention ; Disease transmission ; Efficiency, Organizational - economics ; Epidemics ; Epidemics - economics ; Geography ; Health aspects ; Health risks ; HIV ; HIV infections ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; Human immunodeficiency virus ; Humans ; Infection ; Infections ; Male ; Males ; Mathematical analysis ; Mathematical models ; Middle Aged ; National Health Programs - economics ; Prevalence ; Risk assessment ; Risk groups ; Risk taking ; Scaling ; Sexual Behavior ; Sexually transmitted diseases ; STD ; Voluntary Programs - economics ; Young Adult ; Zambia - epidemiology</subject><ispartof>PloS one, 2015-12, Vol.10 (12), p.e0145729-e0145729</ispartof><rights>COPYRIGHT 2015 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”) Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-be63f489b172730181e9eacbb8cdbdc9d2c35f457ea28c87302ebb55b618ea703</citedby><cites>FETCH-LOGICAL-c758t-be63f489b172730181e9eacbb8cdbdc9d2c35f457ea28c87302ebb55b618ea703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696770/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696770/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26716442$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Awad, Susanne F</creatorcontrib><creatorcontrib>Sgaier, Sema K</creatorcontrib><creatorcontrib>Tambatamba, Bushimbwa C</creatorcontrib><creatorcontrib>Mohamoud, Yousra A</creatorcontrib><creatorcontrib>Lau, Fiona K</creatorcontrib><creatorcontrib>Reed, Jason B</creatorcontrib><creatorcontrib>Njeuhmeli, Emmanuel</creatorcontrib><creatorcontrib>Abu-Raddad, Laith J</creatorcontrib><title>Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia.
A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15-49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20-24 age-group) to 36 (45-49 age-group); cost-effectiveness ranged from $888 (20-24 age-group) to $3,300 (45-49 age-group). Circumcising 10-14, 15-19, or 20-24 year old achieved the largest incidence rate reduction; prioritizing 15-24, 15-29, or 15-34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9-12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs.
Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>AIDS</subject><subject>Antiretroviral drugs</subject><subject>Child</subject><subject>Circumcision</subject><subject>Circumcision, Male - economics</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis - economics</subject><subject>Development and progression</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Efficiency, Organizational - economics</subject><subject>Epidemics</subject><subject>Epidemics - economics</subject><subject>Geography</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infection</subject><subject>Infections</subject><subject>Male</subject><subject>Males</subject><subject>Mathematical analysis</subject><subject>Mathematical models</subject><subject>Middle Aged</subject><subject>National Health Programs - economics</subject><subject>Prevalence</subject><subject>Risk assessment</subject><subject>Risk groups</subject><subject>Risk taking</subject><subject>Scaling</subject><subject>Sexual Behavior</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>Voluntary Programs - economics</subject><subject>Young Adult</subject><subject>Zambia - epidemiology</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk89u1DAQxiMEoqXwBggsISE47GLH-dsD0mpVykqtiij0wMWyHSdx5djBdirKc_DAeLNptUE9oBySOL_5ZvLNTBS9RHCJcI4-XJvBaqqWvdFiCVGS5nH5KDpEJY4XWQzx473ng-iZc9cQprjIsqfRQZzlKEuS-DD6s9E3wnnZUC91A66MGrSn9haci0pyqsA5VQKspeVDx6WTRoMv1jSWduCkriWXQvNbcEqldsC31gxNCy4H1pt-UEFyxKWx0svf4-sx2Ggnm9Y7UFvTgVXfq5BnJL0BP2jHJH0ePampcuLFdD-Kvn86-bb-vDi7ON2sV2cLnqeFXzCR4TopSobyOMcQFUiUgnLGCl6xipdVzHFaB2MEjQteBCQWjKUpy1AhaA7xUfR6p9sr48hkqCMoT-O0wDDLA7HZEZWh16S3sgveEEMlGQ-MbQi1XnIlSC5KTmvO6oqyJNTFMIeQZqEWKBCLk6D1cco2sE5UXGhvqZqJzr9o2ZLG3JAkK7N8LPfdJGDNzyF0jXTScaEU1cIMY904SZK02OZ68w_68N9NVBOaTKSuTcjLt6JkleAiuJpiFKjlA1S4KtFJHqavluF8FvB-FhAYL375hg7Okc3l1_9nL67m7Ns9thVU-daFgd0Oj5uDyQ7k1jhnRX1vMoJkuzx3bpDt8pBpeULYq_0G3QfdbQv-C4s9GR4</recordid><startdate>20151230</startdate><enddate>20151230</enddate><creator>Awad, Susanne F</creator><creator>Sgaier, Sema K</creator><creator>Tambatamba, Bushimbwa C</creator><creator>Mohamoud, Yousra A</creator><creator>Lau, Fiona K</creator><creator>Reed, Jason B</creator><creator>Njeuhmeli, Emmanuel</creator><creator>Abu-Raddad, Laith J</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20151230</creationdate><title>Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia</title><author>Awad, Susanne F ; Sgaier, Sema K ; Tambatamba, Bushimbwa C ; Mohamoud, Yousra A ; Lau, Fiona K ; Reed, Jason B ; Njeuhmeli, Emmanuel ; Abu-Raddad, Laith J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-be63f489b172730181e9eacbb8cdbdc9d2c35f457ea28c87302ebb55b618ea703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>AIDS</topic><topic>Antiretroviral drugs</topic><topic>Child</topic><topic>Circumcision</topic><topic>Circumcision, Male - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Awad, Susanne F</au><au>Sgaier, Sema K</au><au>Tambatamba, Bushimbwa C</au><au>Mohamoud, Yousra A</au><au>Lau, Fiona K</au><au>Reed, Jason B</au><au>Njeuhmeli, Emmanuel</au><au>Abu-Raddad, Laith J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-12-30</date><risdate>2015</risdate><volume>10</volume><issue>12</issue><spage>e0145729</spage><epage>e0145729</epage><pages>e0145729-e0145729</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia.
A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15-49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20-24 age-group) to 36 (45-49 age-group); cost-effectiveness ranged from $888 (20-24 age-group) to $3,300 (45-49 age-group). Circumcising 10-14, 15-19, or 20-24 year old achieved the largest incidence rate reduction; prioritizing 15-24, 15-29, or 15-34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9-12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs.
Epidemic impact and efficiency of VMMC programs can be improved by prioritizing young males (sexually active or just before sexual debut), geographic areas with higher HIV prevalence than the national, and high sexual-risk groups.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26716442</pmid><doi>10.1371/journal.pone.0145729</doi><tpages>e0145729</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1752583067 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Acquired immune deficiency syndrome Adolescent Adult Age AIDS Antiretroviral drugs Child Circumcision Circumcision, Male - economics Cost analysis Cost-Benefit Analysis - economics Development and progression Disease prevention Disease transmission Efficiency, Organizational - economics Epidemics Epidemics - economics Geography Health aspects Health risks HIV HIV infections HIV Infections - epidemiology HIV Infections - prevention & control Human immunodeficiency virus Humans Infection Infections Male Males Mathematical analysis Mathematical models Middle Aged National Health Programs - economics Prevalence Risk assessment Risk groups Risk taking Scaling Sexual Behavior Sexually transmitted diseases STD Voluntary Programs - economics Young Adult Zambia - epidemiology |
| title | Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T15%3A11%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Investigating%20Voluntary%20Medical%20Male%20Circumcision%20Program%20Efficiency%20Gains%20through%20Subpopulation%20Prioritization:%20Insights%20from%20Application%20to%20Zambia&rft.jtitle=PloS%20one&rft.au=Awad,%20Susanne%20F&rft.date=2015-12-30&rft.volume=10&rft.issue=12&rft.spage=e0145729&rft.epage=e0145729&rft.pages=e0145729-e0145729&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0145729&rft_dat=%3Cgale_plos_%3EA438727531%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1752583067&rft_id=info:pmid/26716442&rft_galeid=A438727531&rft_doaj_id=oai_doaj_org_article_7e9cafcbfdab43f4b3c00a68cd0e1b24&rfr_iscdi=true |