Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making?

Hankins, Catherine; Hargrove, John W.; Williams, Brian G.; Raddad, Laith Abu; Auvert, Bertran; Bollinger, L; Dorrington, Rob; Ghani, Azra C.; Gray, Ronald H.; Hallett, Timothy B.; Kahn, Jessica A.; Lohse, Nicolai; Nagelkerke, Nico; Porco, Travis C.; Schmid, George P.; Stover, John; Weiss, Helen A.; Welte, Alex; White, Peter J; White, Richard Grant; Mod, Unaids Who Sacema Expert Grp

doi:10.1371/journal.pmed.1000109

Cited by 113 publications

(89 citation statements)

References 32 publications

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“…HIV-1 uninfected, uncircumcised men in serodiscordant partnerships are a priority for roll-out of male circumcision in high HIV-1 prevalence settings [6]. An encouraging finding was that almost half of HIV-1 uninfected, uncircumcised men in this sample of serodiscordant couples in Kampala expressed interest in circumcision for HIV-1 prevention and almost 90% of their HIV-1 seropositive female partners.…”

Section: Discussionmentioning

confidence: 88%

“…Programs to roll-out male circumcision have subsequently been initiated in several African countries [5]. Recently, UNAIDS/WHO/SACEMA summarized mathematical modeling of expected impact of male circumcision on HIV-1 incidence [6] which indicates the utility of targeting high-risk men, including HIV-1 seronegative men in serodiscordant couples (i.e., in which one partner was HIV-1 seropositive and the other partner was HIV-1 seronegative), a population at high risk for HIV-1 transmission [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

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Knowledge and Attitudes About Male Circumcision for HIV-1 Prevention among Heterosexual HIV-1 Serodiscordant Partnerships in Kampala, Uganda

et al. 2010

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Male circumcision for HIV-1 prevention will require high uptake among at-risk populations. 318 HIV-1 serodiscordant couples in Kampala, Uganda [155 (48.7%) with HIV-1 uninfected male partners] were interviewed about male circumcision for HIV-1 prevention. 77.1% of men and 89.6% of women were aware that circumcision reduces men’s risk for HIV-1 acquisition. Almost all understood the partial protective efficacy of circumcision for HIV-1 acquisition and lack of reduced HIV-1 transmission from circumcising HIV-1 infected men. Among couples with uncircumcised HIV-1 negative men (n = 92), 53.3% of men and 88.1% of female partners expressed interest in male circumcision. Previous discussion within the couple about circumcision for HIV-1 prevention was significantly associated with interest in the procedure. HIV-1 serodiscordant couples in Uganda demonstrated a high level of understanding of the partial protective effect of male circumcision for HIV-1 prevention, but only half of HIV-1 uninfected uncircumcised men expressed interest in the procedure.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Knowledge and Attitudes About Male Circumcision for HIV-1 Prevention among Heterosexual HIV-1 Serodiscordant Partnerships in Kampala, Uganda

et al. 2010

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“…While a cost-effectiveness analysis was beyond the scope of this study, the intervention is likely to be highly cost effective given estimates that 1 HIV infection can be averted for every 5 to 15 VMMCs performed and given lifetime HIV treatment costs. 27–29 The sustainability of the intervention is also enhanced because it is for a 1-time behavior rather than a recurring health behavior. The 1-time compensation amounts in the study, which equated to roughly 1 to 3 days of wages in the case of the US $8.75 and US $15.00 vouchers as well as transportation costs, compare favorably to the amounts used in other studies of incentives to modify health behavior.…”

Section: Discussionmentioning

confidence: 99%

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

Thirumurthy

Masters

Rao

et al. 2014

JAMA

115

133

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IMPORTANCE Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy. OBJECTIVE To determine whether small economic incentives could increase circumcision prevalence by addressing reported economic barriers to VMMC and behavioral factors such as present-biased decision making. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted between June 22, 2013, and February 4, 2014, among 1504 uncircumcised men aged 25 to 49 years in Nyanza region, Kenya. VMMC services were provided free of charge and participants were randomized to 1 of 3 intervention groups or a control group. INTERVENTIONS Participants in the 3 intervention groups received varying amounts of compensation conditional on undergoing circumcision at 1 of 9 study clinics within 2 months of enrollment. Compensation took the form of food vouchers worth 200 Kenya shillings (≈US $2.50), 700 Kenya shillings (≈US $8.75), or 1200 Kenya shillings (≈US $15.00), which reflected a portion of transportation costs and lost wages associated with getting circumcised. The control group received no compensation. MAIN OUTCOMES AND MEASURES VMMC uptake within 2 months. RESULTS Analysis of data for 1502 participants with complete data showed that VMMC uptake within 2 months was higher in the US $8.75 group (6.6%; 95% CI, 4.3%–9.5% [25 of 381]) and the US $15.00 group (9.0%; 95% CI, 6.3%–12.4% [34 of 377]) than in the US $2.50 group (1.9%; 95% CI, 0.8%–3.8% [7 of 374]) and the control group (1.6%; 95% CI, 0.6%–3.5% [6 of 370]). In logistic regression analysis, the US $8.75 group had significantly higher VMMC uptake than the control group (adjusted odds ratio [AOR] 4.3; 95% CI, 1.7–10.7), as did the US $15.00 group (AOR 6.2; 95% CI, 2.6–15.0). Effect sizes for the US $8.75 and US $15.00 groups did not differ significantly (P = .20). CONCLUSIONS AND RELEVANCE Among uncircumcised men in Kenya, compensation in the form of food vouchers worth approximately US $8.75 or US $15.00, compared with lesser or no compensation, resulted in a modest increase in the prevalence of circumcision after 2 months. The effects of more intense promotion or longer implementation require further investigation.

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“…MC scale-up programs which reach coverage targets in sub-Saharan Africa by 2015 are projected to prevent 22% of new HIV infections through 2025 (69). In a high HIV prevalence setting, each averted HIV infection would require 5 to 15 circumcision procedures (70). Furthermore, models suggest that as an HIV prevention method, MC is highly cost-effective and potentially cost saving after a period of scale-up (71; 72).…”

Section: Scale-up and Potential For Large-scale Impactmentioning

confidence: 99%

Male Circumcision: A Globally Relevant but Under-Utilized Method for the Prevention of HIV and Other Sexually Transmitted Infections

2014

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Randomized trials have demonstrated that male circumcision (MC) reduces heterosexual acquisition of HIV, herpes simplex virus type-2, human papillomavirus (HPV), and genital ulcer disease (GUD) among men, and reduces HPV, GUD, bacterial vaginosis and trichomoniasis among female partners. The pathophysiology behind these effects is multifactorial, relying on anatomic and cellular changes. MC is cost-effective and potentially cost saving in both the US and Africa. The WHO and Joint United Nations Program on HIV/AIDS proposed reaching 80% MC coverage in HIV endemic countries, but current rates fall far behind targets. Barriers to scale-up include supply-side and demand-side challenges. In the US, neonatal MC rates are decreasing, but the American Academy of Pediatrics now recognizes the medical benefits of MC and supports insurance coverage. While MC is a globally valuable tool to prevent HIV and other sexually transmitted infections, it is under-utilized. Further research is needed to address barriers to MC uptake.

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Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making?

Abstract: Experts from UNAIDS, WHO, and the South African Centre for Epidemiological Modelling report their review of mathematical models estimating the impact of male circumcision on HIV incidence in high HIV prevalence settings

Cited by 113 publications

References 32 publications

Knowledge and Attitudes About Male Circumcision for HIV-1 Prevention among Heterosexual HIV-1 Serodiscordant Partnerships in Kampala, Uganda

Knowledge and Attitudes About Male Circumcision for HIV-1 Prevention among Heterosexual HIV-1 Serodiscordant Partnerships in Kampala, Uganda

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

Male Circumcision: A Globally Relevant but Under-Utilized Method for the Prevention of HIV and Other Sexually Transmitted Infections

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