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

Abstract

BackgroundDespite 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 FindingsThe 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.ConclusionsThe 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.

Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

“…Prior analyses in other countries [12] projected the impact and cost-effectiveness of scaling up to 80% MC coverage in various age groups. Fig 2 shows a series of hypothetical scenarios in which VMMC is scaled up to 80% coverage in individual five-year age groups in Zimbabwe by 2018 and maintained at that level of coverage thereafter.…”

“…The general limitations of the DMPPT 2.0 model are discussed in the methods paper in this collection [12] and they also apply to this analysis. The primary limitations of this particular analysis are the assumptions about the level at which male circumcision coverage would plateau in each age group, and the fact that the actual relationship between cost and increased coverage by age group is unknown.…”

“…The DMPPT 2.0 model is described in detail in Kripke, Opuni, Schnure, et al [12]. Briefly, DMPPT 2.0 is a simple compartmental model, implemented in Microsoft Excel 2010, that is designed to analyze the effects of age at circumcision on program impact and cost.…”

“…In addition, barriers to circumcision that exist for older men, such as time away from work, are less of an issue for adolescents [11]. Partly as a result of these observations, our team developed the Decision Makers’ Program Planning Tool (DMPPT), Version 2.0 to examine the impact and cost-effectiveness of circumcising different age groups of males [12]. …”

Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography

“…The Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0), developed by the USAID- and PEPFAR-funded Health Policy Project [27], is a compartmental model that allows the user to analyze the effects of VMMC client age and of geography on program impact and cost-effectiveness. This model was applied to five countries [28], all of which subsequently made policy decisions based on the modeling results.…”