The cost and impact of male circumcision on HIV/AIDS in Botswana

Abstract

The HIV/AIDS epidemic continues to be a major issue facing Botswana, with overall adult HIV prevalence estimated to be 25.7 percent in 2007. This paper estimates the cost and impact of the draft Ministry of Health male circumcision strategy using the UNAIDS/WHO Decision-Makers' Programme Planning Tool (DMPPT). Demographic data and HIV prevalence estimates from the recent National AIDS Coordinating Agency estimations are used as input to the DMPPT to estimate the impact of scaling-up male circumcision on the HIV/AIDS epidemic. These data are supplemented by programmatic information from the draft Botswana National Strategy for Safe Male Circumcision, including information on unit cost and program goals. Alternative scenarios were developed in consultation with stakeholders. Results suggest that scaling-up adult and neonatal circumcision to reach 80% coverage by 2012 would result in averting almost 70,000 new HIV infections through 2025, at a total net cost of US$47 million across that same period. This results in an average cost per HIV infection averted of US$689. Changing the target year to 2015 and the scale-up pattern to a linear pattern results in a more evenly-distributed number of MCs required, and averts approximately 60,000 new HIV infections through 2025. Other scenarios explored include the effect of risk compensation and the impact of increasing coverage of general prevention interventions. Scaling-up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly; program design elements such as feasible patterns of scale-up and inclusion of counselling are important in evaluating the overall success of the program.

Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya

“…Several modeling studies found that the longterm population-level impact of widespread implementation and scale-up of voluntary medical male circumcision (VMMC) services will result in substantial reductions in HIV incidence for both men and women [8][9][10][11][12]. As a result, ten of the fourteen high-priority countries are actively engaged in national VMMC program scale-up [13][14][15].…”

The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a probabilistic decision model

“…There is evidence to suggest that adult male circumcision (AMC) can be a cost-effective strategy for prevention of heterosexual acquisition of HIV in men. Several economic evaluations [11][12][13][14][15] have shown that AMC is cost effective, or even cost saving (a cost-saving intervention is one that actually saves society money in the long run by preventing costly medical care) for the prevention of heterosexual acquisition of HIV in men. A preliminary examination of the existing economic evaluations suggests that, studies have tended to focus on population in a limited geographic area, have expressed results in terms of cost per HIV infection averted (HIA), or have not considered DALYs [16].…”

Circumcision in Children

“…Since long, phimosis has been considered as a predisposing factor for penile and cervical cancer and circumcision has been shown to reduce the incidence. In the HIV prevalent areas, circumcision has been advocated to decrease transmission of the disease [9]. Transmission of other sexually transmitted diseases has also been shown to reduce by routine circumcision.…”