Voluntary Medical Male Circumcision for HIV Prevention in Swaziland: Modeling the Impact of Age Targeting
Voluntary Medical Male Circumcision for HIV Prevention in Swaziland: Modeling the Impact of Age Targeting
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DOI：
10.1371/journal.pone.0156776
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发表时间：
2016-07-13
期刊：
影响因子：
3.7
通讯作者：
Njeuhmeli, Emmanuel
中科院分区：
文献类型：
--
作者：
Kripke, Katharine;Okello, Velephi;Njeuhmeli, Emmanuel
自2009年以来，斯威士兰一直将自愿医疗男性包皮环切术（VMMC）作为预防艾滋病毒的优先事项。卫生部最初侧重于15至49岁的男子，鉴于10至15岁的现有需求，2012年将VMMC的最低年龄从15岁降至10岁。为了了解将VMMC服务提供重点放在特定年龄组的影响，卫生部在2013- 2014年开展了一项建模工作，为政策和实施提供信息。方法和结果使用决策者计划规划工具2.0版（DMPPT 2.0）（一个简单的房室模型）评估特定年龄组包皮环切术的影响和成本。我们使用斯威士兰艾滋病毒发病率测量调查（SHIMS）的年龄特异性艾滋病毒发病率。人口、死亡率、出生率和艾滋病毒流行率是从最近与国家利益攸关方协商更新的国家频谱/目标模型中输入的。基线男性包皮环切术流行率来自斯威士兰最近的人口和健康调查。当年龄在15-19岁、20-24岁、25-29岁和30-34岁的男性接受包皮环切术时，每避免一次艾滋病毒感染的VMMC数量最低，尽管估计值的不确定性界限重叠。25-29岁和20-24岁的男性包皮环切术最直接地降低了艾滋病毒的发病率。年龄在15-19岁、20-24岁和25-29岁之间的男性行包皮环切术，在15年内降低发病率的幅度最大。避免每艾滋病毒感染的最低成本是通过包皮环切男性年龄15-34：$870美元（USD）.ConclusionsThe潜在的影响，成本和成本效益的VMMC规模在斯威士兰是不统一的。它们因受割礼男子的年龄组而异。根据这一示范活动的结果，卫生部的《2014-2018年斯威士兰男性包皮环切战略和行动计划》通过了一项执行战略，要求将包皮环切的覆盖率扩大到新生儿50%，10-29岁男性80%，30-34岁男性55%。
BackgroundVoluntary medical male circumcision (VMMC) for HIV prevention has been a priority for Swaziland since 2009. Initially focusing on men ages 15-49, the Ministry of Health reduced the minimum age for VMMC from 15 to 10 years in 2012, given the existing demand among 10- to 15-year-olds. To understand the implications of focusing VMMC service delivery on specific age groups, the MOH undertook a modeling exercise to inform policy and implementation in 2013-2014.Methods and FindingsThe impact and cost of circumcising specific age groups were assessed using the Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0), a simple compartmental model. We used age-specific HIV incidence from the Swaziland HIV Incidence Measurement Survey (SHIMS). Population, mortality, births, and HIV prevalence were imported from a national Spectrum/Goals model recently updated in consultation with country stakeholders. Baseline male circumcision prevalence was derived from the most recent Swaziland Demographic and Health Survey. The lowest numbers of VMMCs per HIV infection averted are achieved when males ages 15-19, 20-24, 25-29, and 30-34 are circumcised, although the uncertainty bounds for the estimates overlap. Circumcising males ages 25-29 and 20-24 provides the most immediate reduction in HIV incidence. Circumcising males ages 15-19, 20-24, and 25-29 provides the greatest magnitude incidence reduction within 15 years. The lowest cost per HIV infection averted is achieved by circumcising males ages 15-34: $870 U.S. dollars (USD).ConclusionsThe potential impact, cost, and cost-effectiveness of VMMC scale-up in Swaziland are not uniform. They vary by the age group of males circumcised. Based on the results of this modeling exercise, the Ministry of Health's Swaziland Male Circumcision Strategic and Operational Plan 2014-2018 adopted an implementation strategy that calls for circumcision to be scaled up to 50% coverage for neonates, 80% among males ages 10-29, and 55% among males ages 30-34.