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Scaling up voluntary medical male circumcision. Catherine Hankins MD MSc FRCPC Chief Scientific Adviser to UNAIDS Office of the Deputy Executive Director, Programme. THE CUTTING EDGE: What's New in Voluntary Medical Male Circumcision Rome, 19 th International AIDS Society, July 2011. - PowerPoint PPT Presentation
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Scaling up voluntary medical male circumcision
Catherine Hankins MD MSc FRCPCChief Scientific Adviser to UNAIDS
Office of the Deputy Executive Director, Programme
THE CUTTING EDGE: What's New in Voluntary Medical Male Circumcision
Rome, 19th International AIDS Society, July 2011
WHO/UNAIDS Technical Consultation Male Circumcision and HIV Prevention: Research Implications for Policy and Programming Montreux, Switzerland 6- 8 March 2007
Courtesy C Hankins
Male Circumcision Priority Countries
Facilitating Factors in VMMC scale-up• Community buy-in and
engagement of traditional leaders
• Political will and country ownership
• Strategic communication • Strong leadership and
coordination from the Ministry of Health with the National and Provincial MC Task Forces
• Enough resources for service delivery
• Technical support from partners
• Capacity to change strategy as new information becomes available
• Task shifting to clinical officers and nurses
• Mobility of service delivery: taking services to people
• Dedication of sites with campaign style
• Mixed staffing models (public and private/NGO)
• Practicality: temporary services, continuous services
• Innovation
Communicating about partial protection
Male circumcision for HIV prevention in high HIV prevalence settings: What can mathematical modelling contribute to informed decision making? PLoS Medicine 2009: e1000109
UNAIDS/WHO/SACEMA
Women will benefit indirectly, although the effect will be smaller than the direct effect for men and will take longer to develop.
The benefits are likely to be large, with one HIV infection averted for every 5 to 15 male circumcisions performed, using a 10 year horizon.
Circumcised men Women Uncircumcised men Whole population0
20
40
60
80
100
Red
uctio
n in
HIV
inci
denc
e (%
) 5% circumcised20% circumcised35% circumcised50% circumcised70% circumcised90% circumcised
6 modelling teams addressed 8 questions of key concern to policy makers
Population-level Impacts by Coverage
Medical male circumcision is highly cost-effective with costs to avert one HIV infection from US$150-$900 using a 10 year time horizon.
Number of MC needed per Infection Averted from 2011 to 2025
Botswan
a
Ethiop
iaKen
ya
Leso
tho
Malawi
Mozam
bique
Namibi
a
Rwanda
South
Africa
Swazila
nd
Tanza
nia
Ugand
a
Zambia
Zimba
bwe
0
10
20
30
40
50
60
70
8
59
8 5 137
26
44
5 510
198
4
Courtesy Emmanuel Njeuhmeli, PEPFAR
Decision-makers’ programme planning tool• Developed by Futures Institute in collaboration with
UNAIDS under the USAID/Health Policy Initiative • Supports decision makers to understand the cost and
impact of scaling-up male circumcision services by service delivery approach, priority populations, pace of scale-up
• Populations: – All adult males– 15-24 or 15-29 year old males– Adolescents prior to starting sexual activity– Newborns– Men at higher risk of HIV exposure– others
AIDS at 30 Nations at the crossroads
Annual male circumcisions for HIV prevention in eight countries* in Eastern and Southern Africa, 2008–2010
* Kenya, Malawi, Namibia, Rwanda, South Africa, Swaziland, Zambia and Zimbabwe
Thousands
100
200
300
400
2008 2009 20100
Achievement toward target of 80% coverage
Botswan
a
Ethiop
iaKen
ya
Leso
tho
Malawi
Mozam
bique
Namibi
a
Rwanda
South
Africa
Swazila
nd
Tanza
nia
Ugand
a
Zambia
Zimba
bwe
0%
10%
20%
30%
40%
50%
60%
70%
4%
12%
66%
0% 0% 1% 1% 0%3%
14%
3% 0%4%
1%
Courtesy Emmanuel Njeuhmeli, PEPFAR
Supply & Demand - Ideal
VMMC Supply VMMC Demand
Courtesy Jason Reed PEPFAR
Supply & Demand Equation Calculus
Courtesy Jason Reed PEPFAR
Developed by WHO, UNAIDS, AVAC, and FHI
Zero new HIV infections Zero discrimination Zero HIV-related deaths