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Background: Zimbabwe adopted VMMC as a priority prevention strategy in 2007 and began service delivery in 2009 with a target of circumcising 1.3 million men by 2017. The program reached over 500,000 men through mid-2015; 42% under the age of 15. The purpose of this activity is to evaluate the cost and impact of the program achievements to date using multiple mathematical models.
Methods: We collected statistics on the number of VMMC performed through a review of client intake forms and site registers and conducted on-site verification and Internal Quality Audits. Four modeling groups (Avenir Health, Imperial College London, Institute for Disease Modeling, Weill Cornell Medical College) independently initialized mathematical simulation models that replicated historical trends in HIV infection. We compared actual trends in new infections with those that would have occurred if the VMMC program had not existed. A modeling workshop reviewed model results and reached a consensus on the most likely impact of the program.
Results: Results indicate that 4,000 - 8,000 infections have already been averted by the VMMCs conducted to date. The longer term impact will be much greater as these men will be protected throughout their sexually active lives. The contribution of already performed VMMCs will amount to 73,000-75,000 infections averted through 2030. If the VMMC target is reached by 2017 then the program will avert 240,000 - 310,000 new infections through 2030 -- 30% of all new infections -- at a cost of $500 - $1300 per infection averted. Total savings by 2025 will be $110-$250 million.
Conclusions: The VMMC program in Zimbabwe will have a substantial impact in the coming years. The cost per infection averted is low compared to the costs of treatment. Using multiple models and a stakeholders'' workshop led to strong evidence for action being generated.

Number of new infections by scenario
[Number of new infections by scenario]