A Reevaluation of the Voluntary Medical Male Circumcision Scale-Up Plan in Zimbabwe

Background

The voluntary medical male circumcision (VMMC) program in Zimbabwe aims tocircumcise 80% of males aged 13–29 by 2017. We assessed the impact ofactual VMMC scale-up to date and evaluated the impact of potentialalterations to the program to enhance program efficiency, throughprioritization of subpopulations.

Methods and Findings

We implemented a recently developed analytical approach: the age-structuredmathematical (ASM) model and accompanying three-level conceptual frameworkto assess the impact of VMMC as an intervention. By September 2014, 364,185males were circumcised, an initiative that is estimated to avert 40,301 HIVinfections by 2025. Through age-group prioritization, the number of VMMCsneeded to avert one infection (effectiveness) ranged between ten(20–24 age-group) and 53 (45–49 age-group). The cost perinfection averted ranged between $811 (20–24 age-group) and $5,518(45–49 age-group). By 2025, the largest reductions in HIV incidencerate (up to 27%) were achieved by prioritizing 10–14, 15–19,or 20–24 year old. The greatest program efficiency was achieved byprioritizing 15–24, 15–29, or 15–34 year old.Prioritizing males 13–29 year old was programmatically efficient, butslightly inferior to the 15–24, 15–29, or 15–34 agegroups. Through geographic prioritization, effectiveness varied from9–12 VMMCs per infection averted across provinces. Through risk-groupprioritization, effectiveness ranged from one (highest sexual risk-group) to60 (lowest sexual risk-group) VMMCs per infection averted.

Conclusion

The current VMMC program plan in Zimbabwe is targeting an efficient andimpactful age bracket (13–29 year old), but program efficiency can beimproved by prioritizing a subset of males for demand creation and serviceavailability. The greatest program efficiency can be attained byprioritizing young sexually active males and males whose sexual behaviorputs them at higher risk for acquiring HIV.