Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making?
Video by Catherine Hankins of UNAIDS. This relates to an article published in PLoS Medicine in September 2009 in which 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
* Mathematical models can estimate the population-level impact of male circumcision on HIV incidence in high HIV prevalence settings, but different methods, assumptions, and input variables can produce conflicting results.
*UNAIDS/WHO/SACEMA recently convened experts to review the outcomes of six simulation models on key policy and programmatic decision-making questions.
*Large benefits of male circumcision among heterosexual men in low male circumcision, high HIV prevalence settings were found: one HIV infection being averted for every five to 15 male circumcisions performed, and costs to avert one HIV infection ranging from US$150 to US$900 using a 10-y time horizon.
*The models predicted that both premature postoperative resumption of sexual intercourse and behavioural risk compensation, if confined to newly or already circumcised men and their partners, have only small population level effects on the anticipated impact of male circumcision service scale-up on HIV incidence.
* Women benefit indirectly from reduced HIV prevalence in circumcised male partners and male circumcision service scale-up acts synergistically with other strategies to reduce HIV disease burden.
* The modelling results have informed development of a pragmatic decision-makers' programme planning tool.
Citation: UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention (2009) Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making? PLoS Med 6(9): e1000109. doi:10.1371/journal.pmed.1000109
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