Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers' Program Planning Toolkit (DMPPT) 2.0

PLoS One. 2016 Jul 13;11(7):e0156909. doi: 10.1371/journal.pone.0156909. eCollection 2016.

Abstract

Background: Despite considerable efforts to scale up voluntary medical male circumcision (VMMC) for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S. President's Plan for AIDS Relief (PEPFAR) supported the development and application of a model to inform national planning in five countries from 2013-2014.

Methods and findings: The Decision Makers' Program Planning Toolkit (DMPPT) 2.0 is a simple compartmental model designed to analyze the effects of client age and geography on program impact and cost. The DMPPT 2.0 model was applied in Malawi, South Africa, Swaziland, Tanzania, and Uganda to assess the impact and cost of scaling up age-targeted VMMC coverage. The lowest number of VMMCs per HIV infection averted would be produced by circumcising males ages 20-34 in Malawi, South Africa, Tanzania, and Uganda and males ages 15-34 in Swaziland. The most immediate impact on HIV incidence would be generated by circumcising males ages 20-34 in Malawi, South Africa, Tanzania, and Uganda and males ages 20-29 in Swaziland. The greatest reductions in HIV incidence over a 15-year period would be achieved by strategies focused on males ages 10-19 in Uganda, 15-24 in Malawi and South Africa, 10-24 in Tanzania, and 15-29 in Swaziland. In all countries, the lowest cost per HIV infection averted would be achieved by circumcising males ages 15-34, although in Uganda this cost is the same as that attained by circumcising 15- to 49-year-olds.

Conclusions: The efficiency, immediacy of impact, magnitude of impact, and cost-effectiveness of VMMC scale-up are not uniform; there is important variation by age group of the males circumcised and countries should plan accordingly.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Circumcision, Male* / economics
  • Circumcision, Male* / statistics & numerical data
  • Cost-Benefit Analysis
  • Decision Making
  • Eswatini / epidemiology
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Health Policy
  • Humans
  • Incidence
  • Malawi / epidemiology
  • Male
  • Models, Statistical
  • National Health Programs* / economics
  • National Health Programs* / statistics & numerical data
  • Software
  • South Africa / epidemiology
  • Tanzania / epidemiology
  • Uganda / epidemiology
  • Voluntary Programs* / economics
  • Voluntary Programs* / statistics & numerical data
  • Young Adult

Grants and funding

This work was funded by the President's Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) | Health Policy Project, Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The Health Policy Project is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). The funder was involved in study design, decision to publish, and preparation of the manuscript. The findings and conclusions in this paper do not necessarily represent the views or positions of USAID or the U.S. Government.