The long-term efficacy of medical male circumcision against HIV acquisition

Mehta, Supriya D.; Moses, Stephen; Agot, Kawango; Odoyo-June, Elijah; Li, Hong; Maclean, Ian; Hedeker, Donald; Bailey, Robert C.

doi:10.1097/01.aids.0000432444.30308.2d

Cited by 57 publications

(53 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We assumed that MMC reduced the risk of HIV acquisition in men by 60% [18] and that suppressive ART reduced the transmission risk by 73%-99% [3] and prolonged survival among HIV-infected persons [4]. PrEP scenarios assumed the scale-up of PrEP in combination with ART and MMC.…”

Section: Interventionsmentioning

confidence: 99%

Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa

et al. 2016

View full text Add to dashboard Cite

Background. Long-acting injectable antiretrovirals such as rilpivirine (RPV) could promote adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. However, the cost-effectiveness of injectable PrEP is unclear.Methods. We constructed a dynamic model of the heterosexual HIV epidemic in KwaZulu-Natal, South Africa, and analyzed scenarios of RPV PrEP scale-up for combination HIV prevention in comparison with a reference scenario without PrEP. We estimated new HIV infections, life-years and costs, and incremental cost-effectiveness ratios (ICERs), over 10-year and lifetime horizons, assuming a societal perspective.Results. Compared with no PrEP, unprioritized scale-up of RVP PrEP covering 2.5%-15% of adults prevented up to 9% of new infections over 10 years. HIV prevention doubled (17%) when the same coverage was prioritized to 20-to 29-year-old women, costing $10 880-$19 213 per infection prevented. Prioritization of PrEP to 80% of individuals at highest behavioral risk achieved comparable prevention (4%-8%) at <1% overall coverage, costing $298-$1242 per infection prevented. Over lifetime, PrEP scale-up among 20-to 29-year-old women was very cost-effective (<$1600 per life-year gained), dominating unprioritized PrEP, while risk prioritization was cost-saving. PrEP's 10-year impact decreased by almost 50% with increases in ICERs (up to 4.2-fold) in conservative base-case analysis. Sensitivity analysis identified PrEP's costs, efficacy, and reliability of delivery as the principal drivers of uncertainty in PrEP's cost-effectiveness, and PrEP remained cost-effective under the assumption of universal access to second-line antiretroviral therapy.Conclusions. Compared with no PrEP, prioritized scale-up of RPV PrEP in KwaZulu-Natal could be very cost-effective or costsaving, but suboptimal PrEP would erode benefits and increase costs.

show abstract

Section: Interventionsmentioning

confidence: 99%

Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Later studies found that this protective effect against HIV is sustained over extended follow up (up to 6 years in the studies) 6 , 7 . As such, in countries with high HIV prevalence, a generalized heterosexual HIV epidemic, and low rates of male circumcision, WHO and UNAIDS recommend safe, voluntary circumcision for adult men as one important component of a comprehensive strategy to prevent HIV 4 …”

Section: Introductionmentioning

confidence: 99%

Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study

Frajzyngier

Odingo

Barone

et al. 2014

Glob Health Sci Pract

View full text Add to dashboard Cite

show abstract

“…These results have been sustained among original study participants (Gray et al 2012; Mehta et al 2013) and in non-study community members who opted for VMMC (Auvert et al 2013). Considering the failures of behaviour change for prevention, treatment as prevention, pre- and post-exposure prophylactics, and vaccines, this level of effectiveness has generated great excitement in global HIV programming and donor institutions and propelled the VMMC approach to the forefront of HIV prevention programming.…”

Section: Introducing and Re-introducing Male Circumcisionmentioning

confidence: 77%

Making voluntary medical male circumcision a viable HIV prevention strategy in high-prevalence countries by engaging the traditional sector

Bulled

Green

2015

Critical Public Health

View full text Add to dashboard Cite

Voluntary medical male circumcision (VMMC) has been rapidly accepted by global HIV policy and donor institutions as a highly valuable HIV prevention strategy given its cost-effectiveness, limited interactions with a health facility, and projected long-lasting benefits. Many southern African countries have incorporated VMMC into their national HIV prevention strategies. However, intensive VMMC promotion programs have met with limited success to date and many HIV researchers have voiced concerns. This commentary discusses reasons behind the less-than-desired public demand and suggests how inclusion of the traditional sector – traditional leaders, healers, and circumcisers – with their local knowledge, cultural expertise and social capital, particularly in the realm of social meanings ascribed to male circumcision, may improve the uptake of this HIV prevention strategy. We offer Lesotho and Swaziland as case studies of the integration of universal VMMC policies; these are countries with a shared HIV burden, yet contrasting contemporary socio-cultural practices of male circumcision. The similar hesitant responses expressed by these two countries towards VMMC remind us that the incorporation of any new or revised and revitalized public health strategy must be considered within unique historical, political, economic, and socio-cultural contexts.

show abstract

The long-term efficacy of medical male circumcision against HIV acquisition

Cited by 57 publications

References 20 publications

Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa

Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa

Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study

Making voluntary medical male circumcision a viable HIV prevention strategy in high-prevalence countries by engaging the traditional sector

Contact Info

Product

Resources

About