The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models.
The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models.
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DOI：
10.12688/gatesopenres.13220.1
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发表时间：
2021
影响因子：
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通讯作者：
Johnson LF
中科院分区：
文献类型：
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作者：
Korenromp EL;Bershteyn A;Mudimu E;Weiner R;Bonecwe C;Loykissoonlal D;Manuhwa C;Pretorius C;Teng Y;Stover J;Johnson LF
背景：南非于2010年开始提供医疗男性包皮环切术（MMC）。我们评估了这个项目目前和未来的影响，看看它是否能有效地预防新的艾滋病毒感染。方法：对Thembisa、Goals和流行病学建模软件（EMOD）艾滋病毒传播模型进行校准，以适应南非的艾滋病毒流行情况，拟合有关艾滋病毒流行率、风险行为和包皮环切男性比例的家庭调查数据，以及2009-2017年干预措施推出的规划数据，包括规划报告的mmc。我们将2017年的实际项目成就和2021年的项目目标与没有MMC项目的反事实情景进行了比较。结果：从2010年到2017年，MMC项目避免了71,000-83,000例新的艾滋病毒感染。到2030年，已经实施的包皮环切术的未来益处将增加到496,000-518,000例感染（占所有新感染的6-7%）。如果到2021年实现项目目标，到2030年可避免感染的人数将增加到72.3万至76万。相对于没有MMC，每次避免感染的成本为1,070-1,220美元。在2034-2039年左右，避免治疗需求所节省的费用将超过MMC项目的成本。在Thembisa模型中，当对南非的9个省进行单独建模时，9个省的综合结果与单一国家模型的结果相似。从各省来看，自由邦、夸祖鲁-纳塔尔省和姆普马兰加省预计的长期影响最大（2017-2030年减少23-27%），反映出这些省份的MMC规模更大。结论：MMC已经对南非的艾滋病毒发病率产生了一定的影响，并可能在未来几年对南非的艾滋病毒流行产生重大影响。
Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.