Voluntary medical male circumcision proves to be highly cost-effective, highlighting need for greater scale-up and sustainability

UNAIDS’ Global AIDS Update – The Road to Ending AIDS highlights two major challenges facing voluntary medical male circumcision (VMMC) programmes: reduced funding and low coverage among men in their twenties and above. Since 2007, when WHO and UNAIDS recommended VMMC as key to HIV prevention in high-endemic areas, approximately 35 million men in 15 VMMC priority countries have received services. While this shows good progress, the Global AIDS Update highlights that VMMC coverage is still far from the global coverage target of 90% to reach many sub-national regions in priority countries. Additionally, funding for the 15 countries funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been cut by nearly half since 2020, from approximately $285 million to $147 million. But as coverage of other biomedical interventions, such as antiretroviral therapy, continues to expand, questions have arisen about the cost-effectiveness of VMMC.

“We need strong political leadership to scale up delivery of VMMC programs; address inequalities that impede progress; and ensure adequate and sustainable funding.” Angeli Achrekar, Deputy Executive Director of Programs at UNAIDS. “Countries that put people and communities first in policies and plans are already leading the way on the road to ending AIDS by 2030.”

VMMC is a simple, safe procedure that has been shown to reduce the risk of HIV transmission in heterosexual men by up to 60%. But is it cost-effective? How long must policymakers continue to promote VMMC among adolescent boys and adult men in VMMC priority countries? These are the findings of a team of researchers.

Now published in The Lancet Global Health, and using 5 existing mathematical models of HIV, the researchers aimed to assess whether delivering VMMC will continue to be an economic resource for HIV programs in sub-Saharan Africa over the next 5 years. use efficiently. The models applied assumptions based on HIV epidemiology in VMMC focus countries, focusing on Malawi, South Africa and Zimbabwe. Impact and cost-effectiveness were projected over 50 years to understand HIV exposure and infection across clients’ lifetimes.

Findings indicate that following VMMC is cost-effective even in settings with low HIV incidence; VMMC is cost-effective in settings where 62% of men aged 15–49 years have HIV incidence rates below 0·1 per 100 person-years effectiveness, whereas in settings where HIV incidence was greater than 1·0 per 100 person-years, the cost-effectiveness of VMMC increased to 95%. The importance of VMMC in sustaining the avoidance of HIV infection and associated healthcare costs was emphasized.

While the details of the results vary by country and model (see Box 1), overall VMMC proved to be highly cost-effective and even cost-saving in almost all countries and scenarios.

Box 1. Results vary across countries South Africa: All models found cost savings from continuing to use VMMC. Malawi: All models agree that continued use of VMMC will result in cost savings. Zimbabwe: Mixed results. Continuing VMMC can be cost-effective in one model but not cost-effective in another. The cost-effectiveness of VMMC depends on HIV incidence in a range of national and regional scenarios in sub-Saharan Africa. Even in settings with low HIV incidence, most prevalence scenarios suggest this is cost-effective.

The authors concluded that despite scaling up of antiretroviral treatment and lower HIV incidence in some settings, there are costs to continuing VMMC for at least the next 5 years in almost all settings considered in this study Efficient.

“Clearly, increased effort and commitment are needed to expand VMMC while maintaining these services to reach men and boys,” said Dr. Meg Doherty, Director of WHO’s Global Program on HIV, Hepatitis and Sexually Transmitted Infections. “New The Global AIDS Report shows that the gap between men is widening and it is important to effectively recognize and address this issue for the sake of their own health and to reduce new infections.”

These analyzes support calls for action to increase efforts to reach men and boys in general and to continue funding VMMC programs. Discussions about VMMC’s sustainability are critical. UNAIDS and WHO urge countries to intensify efforts to expand VMMC to the global coverage target (90%) while addressing program sustainability issues.

In the HIV Prevention Roadmap 2025, VMMC remains a core component of comprehensive HIV prevention with men and boys as the pillars. Not only is it cost-effective, but it can also save money in many cases. Therefore, continued progress towards achieving male circumcision coverage targets in all VMMC priority countries must be accelerated.