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DOI: 10.1371/journal.pone.0156521
论文题名:
Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography
作者: Katharine Kripke; Frank Chimbwandira; Zebedee Mwandi; Faustin Matchere; Melissa Schnure; Jason Reed; Delivette Castor; Sema Sgaier; Emmanuel Njeuhmeli
刊名: PLOS ONE
ISSN: 1932-6203
出版年: 2016
发表日期: 2016-7-13
卷: 11, 期:7
语种: 英语
英文关键词: HIV ; HIV infections ; Malawi ; Age groups ; Circumcision ; Urban areas ; Cost-effectiveness analysis ; Rural areas
英文摘要: Background In 2007, the World Health Organization (WHO) recommended scaling up voluntary medical male circumcision (VMMC) in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region. Methods We used the Decision Makers’ Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of $451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS. Results Over a fifteen-year period, circumcising males ages 10–29 would avert 75% of HIV infections, and circumcising males ages 10–34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15–49. The Ministry of Health’s South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO’s definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product) in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban areas would be both cost-effective and cost-saving, with a VMMC cost per DALY saved of $120 USD and with 15 years of VMMC implementation resulting in lifetime HIV treatment costs savings of $331 million USD. Conclusions Based on the age analyses and programmatic experience, Malawi’s VMMC operational plan focuses on males ages 10–34 in all districts in the South East and South West zones, as well as Lilongwe (an urban district in the Central zone). This plan covers 14 of the 28 districts in the country.
URL: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0156521&type=printable
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资源类型: 期刊论文
标识符: http://119.78.100.158/handle/2HF3EXSE/23313
Appears in Collections:过去全球变化的重建
影响、适应和脆弱性
科学计划与规划
气候变化与战略
全球变化的国际研究计划
气候减缓与适应
气候变化事实与影响

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作者单位: Health Policy Project, Avenir Health, Washington, DC, United States of America;Ministry of Health, Lilongwe, Malawi;United States Agency for International Development (USAID), Lilongwe, Malawi;United States Department of Defense, Lilongwe, Malawi;Health Policy Project, Futures Group, Washington, DC, United States of America;USAID, Washington, DC, United States of America;USAID, Washington, DC, United States of America;Bill & Melinda Gates Foundation, Seattle, Washington, United States of America;University of Washington, Seattle, Washington, United States of America;USAID, Washington, DC, United States of America

Recommended Citation:
Katharine Kripke,Frank Chimbwandira,Zebedee Mwandi,et al. Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography[J]. PLOS ONE,2016-01-01,11(7)
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