20th International AIDS Conference - Melbourne, Australia


THPE344 Poster Exhibition

Estimating the effects of targeting voluntary medical male circumcision (VMMC) programs to different age groups: the decision makers program planning toolkit (DMPPT 2.0)

Presented by Katharine Kripke (United States).

J. Stover1, K. Kripke2

1Health Policy Project, Futures Institute, Center for Modeling, Planning and Policy Analysis, Glastonbury, United States, 2Health Policy Project, Futures Institute, Center for Economics and Costing, Glastonbury, United States

Background: The DMPPT has been used to estimate impact and costs for VMMC programs in many countries. The model and the resulting plans have focused on men ages 15-49 but recent experience shows that most clients are under age 25. Should programs adjust demand creation efforts to focus on older men? The USAID- and PEPFAR-funded Health Policy Project constructed a model to examine the impact and cost of focusing circumcision services on different age groups and regions.
Methods: The model uses local patterns of HIV incidence and circumcision prevalence by age and VMMC efficacy information from clinical trials data to determine the effects of circumcision on HIV incidence. It then calculates the effect of changing circumcision rates on incidence in each age group. The circumcision effects are traced through time as men age and become infected or remain uninfected. Secondary effects on women are also included. The cost of circumcision varies by age depending on the cost of the procedure and the cost of recruiting new clients.
Results: In the short term, circumcising men ages 20-34 will be most effective because that is when most new infections occur. In the long term, younger men would benefit most because a person circumcised at age 20 will be protected through 20 years of high incidence (ages 20-39) while a person circumcised at age 35 will only be protected through 5 years of high incidence (Figure 1). Neonatal circumcision provides lifetime protection, but since the benefits are delayed by 20 years this may not be the most cost-effective option unless costs are significantly lower than adult circumcision and discount rates are low.

DMPPT 2.0 Illustrative Results
[DMPPT 2.0 Illustrative Results]

Conclusions: Male circumcision programs do not need to make special efforts to recruit older men. They are already reaching the most appropriate age groups to maximize impact and cost-effectiveness.

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