Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.
Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.
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DOI：
10.1016/s2214-109x(22)00515-0
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发表时间：
2023-02
影响因子：
34.3
通讯作者：
Bershteyn, Anna
中科院分区：
文献类型：
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作者：
Bansi-Matharu, Loveleen;Mudimu, Edinah;Martin-Hughes, Rowan;Hamilton, Matt;Johnson, Leigh;ten Brink, Debra;Stover, John;Meyer-Rath, Gesine;Kelly, Sherrie L.;Jamieson, Lise;Cambiano, Valentina;Jahn, Andreas;Cowan, Frances M.;Mangenah, Collin;Mavhu, Webster;Chidarikire, Thato;Toledo, Carlos;Revill, Paul;Sundaram, Maaya;Hatzold, Karin;Yansaneh, Aisha;Apollo, Tsitsi;Kalua, Thoko;Mugurungi, Owen;Kiggundu, Valerian;Zhang Shufang;Nyirenda, Rose;Phillips, Andrew;Kripke, Katharine;Bershteyn, Anna
自 2007 年以来，自愿医疗男性包皮环切术 (VMMC) 一直是撒哈拉以南非洲地区推荐的艾滋病毒预防策略，特别是在艾滋病毒感染率高的国家。然而，鉴于抗逆转录病毒治疗计划的扩大，目前尚不清楚 VMMC 是否仍然代表着对稀缺艾滋病毒计划资源的经济有效利用。使用五个现有的详细描述的 HIV 数学模型，我们比较了南非、马拉维和津巴布韦以及撒哈拉以南非洲的一系列环境情景中 15 岁及以上男性持续使用 VMMC 5 年与不再进行 VMMC 的情况。产出基于 50 年时间范围，假设 VMMC 成本为 90 美元，并使用 500 美元的成本效益阈值。根据所有模型，在南非和马拉维，VMMC 持续 5 年都带来了成本节约和健康效益（避免了感染和残疾调整生命年）。在模拟津巴布韦的两个模型中，VMMC 持续 5 年导致一个模型节省了成本并带来了健康效益，但另一个模型的成本效益却不那么高。在撒哈拉以南非洲地区 68% 的场景中，继续实施 VMMC 具有成本效益。在艾滋病毒发病率较高的模拟环境中，VMMC 更有可能具有成本效益； VMMC 在 62% 的 15-49 岁男性 HIV 发病率低于每 100 人年 0·1 的环境中具有成本效益，而当 HIV 发病率高于每 100 人年 1·0 时，VMMC 的成本效益增至 95%。至少在未来 5 年内，VMMC 仍然是撒哈拉以南非洲地区具有成本效益且通常节省成本的预防干预措施。比尔及梅琳达·盖茨艾滋病模型联盟基金会。
Voluntary medical male circumcision (VMMC) has been a recommended HIV prevention strategy in sub-Saharan Africa since 2007, particularly in countries with high HIV prevalence. However, given the scale-up of antiretroviral therapy programmes, it is not clear whether VMMC still represents a cost-effective use of scarce HIV programme resources. Using five existing well described HIV mathematical models, we compared continuation of VMMC for 5 years in men aged 15 years and older to no further VMMC in South Africa, Malawi, and Zimbabwe and across a range of setting scenarios in sub-Saharan Africa. Outputs were based on a 50-year time horizon, VMMC cost was assumed to be US$90, and a cost-effectiveness threshold of US$500 was used. In South Africa and Malawi, the continuation of VMMC for 5 years resulted in cost savings and health benefits (infections and disability-adjusted life-years averted) according to all models. Of the two models modelling Zimbabwe, the continuation of VMMC for 5 years resulted in cost savings and health benefits by one model but was not as cost-effective according to the other model. Continuation of VMMC was cost-effective in 68% of setting scenarios across sub-Saharan Africa. VMMC was more likely to be cost-effective in modelled settings with higher HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 0·1 per 100 person-years in men aged 15–49 years, increasing to 95% with HIV incidence greater than 1·0 per 100 person-years. VMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years. Bill & Melinda Gates Foundation for the HIV Modelling Consortium.