Abstract
Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.
Highlights
Voluntary medical male circumcision (VMMC) has been shown to be effective in reducing the sexual transmission of HIV fromCollection Review articles synthesize in narrative form the best available evidence on a topic
We propose a set of priority focus areas for the global VMMC program and for the governments of the priority countries, and we highlight new areas of opportunity to accelerate scale-up
The PLOS Collection ‘‘Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up’’ includes 13 research papers and an overview that highlight key findings from several countries that have moved to high-volume VMMC services, explore challenges faced, and offer recommendations for programs as they scale up VMMC services
Summary
Voluntary medical male circumcision (VMMC) has been shown to be effective in reducing the sexual transmission of HIV fromCollection Review articles synthesize in narrative form the best available evidence on a topic. N The 13 papers in this collection examine issues of service quality, demand creation, cost, and efficiency faced by governments, donors, and programs.
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