Models to inform fast tracking voluntary medical male circumcision in HIV combination prevention

Übersicht

In preparation for a new phase of voluntary medical male circumcision (VMMC) interventions over the period through 2021, WHO and UNAIDS convened a small consultation of modellers and policy-makers to review and discuss different models and projections, and develop key messages to inform strategic directions over the next five years.

Since the WHO/ UNAIDS recommendation in 2007 that medical male circumcision be considered an additional method of HIV prevention and should be rapidly scaled up in countries with low prevalence of circumcision and high prevalence of HIV, there has been considerable investment in implementing VMMC programmes for HIV prevention in eastern and southern Africa. By end 2015, 11.7 million adolescent and adult males had undergone circumcision through these programmes.

Initial projections of cost and impact of VMMC interventions were developed before the programmes were implemented at scale and based on best assumptions about the course of the HIV epidemic valid at the time of development (2007–2010). These projections need to be revised as circumcision scale-up has not been uniform between and within countries, with greater uptake among adolescent and younger men than men over age 30 years. Similarly, the future impact on HIV incidence and prevalence in focus countries must be projected according to current HIV epidemic estimates and expected declines in HIV incidence resulting from scaling up antiretroviral treatment (ART) to reach the 90 –90 –90 by 2020 and 95–95–95 by 2030 HIV testing and treatment targets.