Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014.
Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014.
复制标题
DOI：
10.1371/journal.pone.0158767
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Bock N
中科院分区：
文献类型：
--
作者：
Kripke K;Njeuhmeli E;Samuelson J;Schnure M;Dalal S;Farley T;Hankins C;Thomas AG;Reed J;Stegman P;Bock N
2007年，世界卫生组织和联合国艾滋病毒/艾滋病联合规划署（艾滋病规划署）确定了东部和南部非洲14个优先国家，以扩大自愿医疗男性包皮环切术服务。这项努力进行了几年，我们对进展进行了反思。使用决策者计划规划工具（DMPPT）2.1，我们评估了特定年龄的影响，成本效益和覆盖率归因于包皮环切术到2014年。我们还比较了实际进展与在12个VMMC优先国家和肯尼亚尼扬扎省实现15-49岁男性80%覆盖率的影响。我们用按年龄分列的VMMC服务统计数据以及从特定国家的Spectrum/Goals文件导出的人口、死亡率和艾滋病毒发病率和流行率预测填充了模型。我们假设每个国家都实现了联合国艾滋病规划署的90-90-90治疗目标。到2014年，进行了900多万次VMMC：到2015年底，估计需要2090万次VMMC中的43%达到80%的覆盖率。该模型假设每个国家都达到了联合国艾滋病规划署的目标，并预测到2025年底，2014年进行的VMMC将避免24万例感染，而如果每个国家在2015年底达到80%的覆盖率，则将避免110万例感染。每一个避免艾滋病毒感染的估计费用中位数为4 400美元。肯尼亚的尼扬扎省、坦桑尼亚的11个优先地区和乌干达已经达到或正在接近15-24岁男性的MC覆盖率目标，而其他年龄组的覆盖率较低。在所有模拟的国家中，预计避免的艾滋病毒感染中有一半以上可归因于10至19岁的包皮环切术。重点国家在扩大病毒、媒介和化学品监测方面取得了相当大的进展，即使假设艾滋病毒诊断、治疗覆盖率和病毒抑制率接近普及，病毒、媒介和化学品监测仍然是一项具有成本效益的战略，可以减轻流行病的影响。审查五岁年龄组的包皮环切手术覆盖率将为各国决定下一步行动提供信息。
In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. Using the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets. More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five-year age groups will inform countries’ decisions about next steps.