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Scaling up voluntary medical male circumcision
Catherine Hankins MD MSc FRCPCChief Scientific Adviser to UNAIDS
Office of the Deputy Executive Director, Programme
THE CUTTING EDGE: What's New in Voluntary Medical Male Circumcision
Rome, 19th International AIDS Society, July 2011
WHO/UNAIDS Technical Consultation Male Circumcision and HIV Prevention: Research Implications for Policy and Programming Montreux, Switzerland 6- 8 March 2007
Courtesy C Hankins
Facilitating Factors in VMMC scale-up
• Community buy-in and engagement of traditional leaders
• Political will and country ownership
• Strategic communication • Strong leadership and
coordination from the Ministry of Health with the National and Provincial MC Task Forces
• Enough resources for service delivery
• Technical support from partners
• Capacity to change strategy as new information becomes available
• Task shifting to clinical officers and nurses
• Mobility of service delivery: taking services to people
• Dedication of sites with campaign style
• Mixed staffing models (public and private/NGO)
• Practicality: temporary services, continuous services
• Innovation
Male circumcision for HIV prevention in high HIV prevalence settings: What can mathematical modelling contribute to informed decision making? PLoS Medicine 2009: e1000109
UNAIDS/WHO/SACEMA
Women will benefit indirectly, although the effect will be smaller than the direct effect for men and will take longer to develop.
The benefits are likely to be large, with one HIV infection averted for every 5 to 15 male circumcisions performed, using a 10 year horizon.
Circumcised men Women Uncircumcised men Whole population0
20
40
60
80
100
Red
uctio
n in
HIV
inci
denc
e (%
) 5% circumcised20% circumcised35% circumcised50% circumcised70% circumcised90% circumcised
6 modelling teams addressed 8 questions of key concern to policy makers
Population-level Impacts by Coverage
Medical male circumcision is highly cost-effective with costs to avert one HIV infection from US$150-$900 using a 10 year time horizon.
Number of MC needed per Infection Averted from
2011 to 2025
Botsw
ana
Ethiop
ia
Kenya
Leso
tho
Mala
wi
Moz
ambiq
ue
Namibi
a
Rwanda
South
Afri
ca
Swazila
nd
Tanza
nia
Ugand
a
Zambia
Zimba
bwe
0
10
20
30
40
50
60
70
8
59
8 5 13
7
26
44
5 510
19
8
4
Courtesy Emmanuel Njeuhmeli, PEPFAR
Decision-makers’ programme planning tool• Developed by Futures Institute in collaboration with
UNAIDS under the USAID/Health Policy Initiative • Supports decision makers to understand the cost and
impact of scaling-up male circumcision services by service delivery approach, priority populations, pace of scale-up
• Populations: – All adult males– 15-24 or 15-29 year old males– Adolescents prior to starting sexual activity– Newborns– Men at higher risk of HIV exposure– others
AIDS at 30 Nations at the crossroads
Annual male circumcisions for HIV prevention in eight countries* in Eastern and Southern Africa, 2008–2010
* Kenya, Malawi, Namibia, Rwanda, South Africa, Swaziland, Zambia and Zimbabwe
Thousands
100
200
300
400
2008 2009 20100
Achievement toward target of 80% coverage
Botsw
ana
Ethiop
ia
Kenya
Leso
tho
Mala
wi
Moz
ambiq
ue
Namibi
a
Rwanda
South
Afri
ca
Swazila
nd
Tanza
nia
Ugand
a
Zambia
Zimba
bwe
0%
10%
20%
30%
40%
50%
60%
70%
4%
12%
66%
0% 0% 1% 1% 0%3%
14%
3% 0%4%
1%
Courtesy Emmanuel Njeuhmeli, PEPFAR