Scaling Up Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention for Adolescents and Young Adult Men: A Modeling Analysis of Implementation and Impact in Selected Countries
Scaling Up Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention for Adolescents and Young Adult Men: A Modeling Analysis of Implementation and Impact in Selected Countries
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DOI：
10.1093/cid/cix969
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发表时间：
2018-04-15
影响因子：
11.8
通讯作者：
Kripke, Katharine
中科院分区：
文献类型：
--
作者：
Njeuhmeli, Emmanuel;Opuni, Marjorie;Kripke, Katharine
背景新的世界卫生组织和联合国艾滋病毒/艾滋病联合规划署自愿医疗男性包皮环切术（VMMC）战略框架旨在到2021年将VMMC在10-29岁男性中的覆盖率提高到90%。我们使用数学建模来评估选定国家实现这一目标的可能性，考虑到他们的历史VMMC进展和当前的实施方案。我们使用决策者计划规划工具包第2版，研究从2017年到2021年扩大VMMC覆盖范围的4个雄心勃勃但可行的情景，包括莱索托，马拉维，莫桑比克，纳米比亚，南非，斯威士兰，坦桑尼亚，乌干达和津巴布韦。坦桑尼亚是唯一一个在所评估的情景中，到2021年底将在10至29岁人群中实现90% VMMC覆盖率目标的国家，这在所研究的情景中有3个是真实的。莫桑比克、南非和莱索托只有在所审查的最雄心勃勃的设想方案中才能接近实现这一目标。大多数国家需要对VMMC实施进行重大改革，以便到2021年底将10至29岁的包皮环切比例提高到90%。要扩大10至29岁男性的生殖器切割手术覆盖面，就需要大幅增加10至14岁和15至29岁男性的包皮环切手术数量。
Background. The new World Health Organization and Joint United Nations Programme on HIV/AIDS strategic framework for voluntary medical male circumcision (VMMC) aims to increase VMMC coverage among males aged 10-29 years in priority settings to 90% by 2021. We use mathematical modeling to assess the likelihood that selected countries will achieve this objective, given their historical VMMC progress and current implementation options.Methods. We use the Decision Makers' Program Planning Toolkit, version 2, to examine 4 ambitious but feasible scenarios for scaling up VMMC coverage from 2017 through 2021, inclusive in Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Uganda, and Zimbabwe.Results. Tanzania is the only country that would reach the goal of 90% VMMC coverage in 10- to 29-year-olds by the end of 2021 in the scenarios assessed, and this was true in 3 of the scenarios studied. Mozambique, South Africa, and Lesotho would come close to reaching the objective only in the most ambitious scenario examined.Conclusions. Major changes in VMMC implementation in most countries will be required to increase the proportion of circumcised 10- to 29-year-olds to 90% by the end of 2021. Scaling up VMMC coverage in males aged 10-29 years will require significantly increasing the number of circumcisions provided to 10- to 14-year-olds and 15- to 29-year-olds.