The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

Eline L Korenromp; Anna Bershteyn; Edina Mudimu; Renay Weiner; Collen Bonecwe; Dayanund Loykissoonlal; Clarence Manuhwa; Carel Pretorius; Yu Teng; John Stover; Leigh F Johnson

doi:10.12688/gatesopenres.13220.1

The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

Gates Open Res. 2021 Jan 25:5:15. doi: 10.12688/gatesopenres.13220.1. eCollection 2021.

Authors

Eline L Korenromp¹, Anna Bershteyn², Edina Mudimu³, Renay Weiner⁴, Collen Bonecwe⁵, Dayanund Loykissoonlal⁵, Clarence Manuhwa^{6

7}, Carel Pretorius⁸, Yu Teng⁸, John Stover⁸, Leigh F Johnson⁹

Affiliations

¹ Center for Modeling and Analysis, Avenir Health, Geneva, Switzerland.
² Department of Population and Health, NYU Langone Medical Center, New York, NY, 11016, USA.
³ Department of Decision Sciences, University of South Africa (UNISA), Pretoria, 0003, South Africa.
⁴ Research and Training for Health and Development, Johannesburg, 2196, South Africa.
⁵ National Department of Health, Pretoria, South Africa.
⁶ FHI 360, Pretoria, 0083, South Africa.
⁷ Independent Consultant, Pretoria, 0083, South Africa.
⁸ Center for Modeling and Analysis, Avenir Health, Glastonbury, CT, 06033, USA.
⁹ Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.

Abstract

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.

Keywords: HIV; cost-effectiveness; health impact; mathematical modeling; prevention; program evaluation.

Associated data

Dryad/10.5061/dryad.b8gtht7bp

Grants and funding

The project was funded by the Bill & Melinda Gates Foundation through a grant [OPP1118702] to Avenir Health with JS as Principal Investigator. UNAIDS supported the updating and development of the Thembisa model through a grant to LFJ.