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Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets
- Source :
- PLoS ONE, Vol 11, Iss 10, p e0155734 (2016), PLoS ONE
- Publication Year :
- 2016
- Publisher :
- Public Library of Science (PLoS), 2016.
-
Abstract
- Background The report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for World AIDS Day 2014 highlighted a Fast-Track Strategy that sets ambitious treatment and prevention targets to reduce global HIV incidence to manageable levels by 2020 and end the AIDS epidemic by 2030. The 90-90-90 treatment targets for 2020 call for 90% of people living with HIV to know their HIV status, 90% of people who know their status to receive treatment, and 90% of people on HIV treatment to be virally suppressed. This paper examines how scale-up of voluntary medical male circumcision (VMMC) services in four priority countries in sub-Saharan Africa could contribute to ending the AIDS epidemic by 2030 in the context of concerted efforts to close the treatment gap, and what the impact of VMMC scale-up would be if the 90-90-90 treatment targets were not completely met. Methods Using the Goals module of the Spectrum suite of models, this analysis modified ART (antiretroviral treatment) scale-up coverage from base scenarios to reflect the 90-90-90 treatment targets in four countries (Lesotho, Malawi, South Africa, and Uganda). In addition, a second scenario was created to reflect viral suppression levels of 75% instead of 90%, and a third scenario was created in which the 90-90-90 treatment targets are reached in women, with men reaching more moderate coverage levels. Regarding male circumcision (MC) coverage, the analysis examined both a scenario in which VMMCs were assumed to stop after 2015, and one in which MC coverage was scaled up to 90% by 2020 and maintained at 90% thereafter. Results Across all four countries, scaling up VMMC is projected to provide further HIV incidence reductions in addition to those achieved by reaching the 90-90-90 treatment targets. If viral suppression levels only reach 75%, scaling up VMMC leads to HIV incidence reduction to nearly the same levels as those achieved with 90-90-90 without VMMC scale-up. If only women reach the 90-90-90 targets, scaling up VMMC brings HIV incidence down to near the levels projected with 90-90-90 without VMMC scale-up. Regarding cost, scaling up VMMC increases the annual costs during the scale-up phase, but leads to lower annual costs after the MC coverage target is achieved. Conclusions The scenarios modeled in this paper show that the highly durable and effective male circumcision intervention increases epidemic impact levels over those of treatment-only strategies, including the case if universal levels of viral suppression in men and women are not achieved by 2020. In the context of 90-90-90, prioritizing continued successful scale-up of VMMC increases the possibility that future generations will be free not only of AIDS but also of HIV.
- Subjects :
- Male
RNA viruses
Viral Diseases
Malawi
Epidemiology
Cost-Benefit Analysis
Human immunodeficiency virus (HIV)
lcsh:Medicine
HIV Infections
030204 cardiovascular system & hematology
medicine.disease_cause
Pathology and Laboratory Medicine
Geographical Locations
South Africa
0302 clinical medicine
Immunodeficiency Viruses
Circumcision
Medicine and Health Sciences
Uganda
030212 general & internal medicine
Hiv treatment
Program Development
Reproductive System Procedures
Circumcision for HIV prevention
lcsh:Science
Multidisciplinary
Cost–benefit analysis
Incidence (epidemiology)
Incidence
HIV diagnosis and management
Lesotho
AIDS
Infectious Diseases
Anti-Retroviral Agents
Male circumcision
Medical Microbiology
HIV epidemiology
Viral Pathogens
Viruses
Female
Pathogens
Research Article
Adult
United Nations
HIV prevention
Context (language use)
Surgical and Invasive Medical Procedures
Microbiology
03 medical and health sciences
Acquired immunodeficiency syndrome (AIDS)
Retroviruses
medicine
Humans
Microbial Pathogens
Preventive medicine
Biology and life sciences
business.industry
Lentivirus
lcsh:R
Organisms
Correction
HIV
medicine.disease
Diagnostic medicine
Public and occupational health
Circumcision, Male
Turnover
Immunology
People and Places
Africa
lcsh:Q
business
Demography
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 11
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....f62e2ba6a1bdde2b2dbabe55cc4ade69