Voluntary Medical Male Circumcision to Prevent HIV: Modelling Age Prioritization in Namibia

Peter Stegman,Emmanuel Njeuhmeli,Brad Corner,Ella Shihepo,Denis Mali,Katharine Kripke,Melissa Schnure,Bridget Stirling

doi:10.1007/s10461-019-02556-y

Abstract

Voluntary Medical Male circumcision (VMMC) has been part of prevention in Namibia since 2009. Yet, as of 2013, VMMC coverage among 15- to 24-year-olds was estimated at less than 22%. Program data suggests uptake of VMMC below age 15 is lower than expected, given the age distribution of the eligible population. Nearly 85% of VMMCs were for males between ages 15 and 29, while boys 10–14 years were referred outside the program. This analysis uses the Decision Makers Program Planning Tool to understand the impact of age prioritization on circumcision in Namibia. Results indicate that circumcising males aged 20–29 reduced HIV incidence most rapidly, while focusing on ages 15–24 was more cost effective and produced greater magnitude of impact. Providing services to those under 15 could increase VMMC volume 67% while introducing Early Infant Medical Circumcision could expand coverage. This exercise supported a review of VMMC strategies and implementation, with Namibia increasing coverage among 10- to 14-year-olds nearly 20 times from 2016 to 2017.

Highlights

A country of just 2.5 million people, Namibia has made progress over the past decade in reducing the spread of the human immunodeficiency virus (HIV) and death from acquired immune deficiency syndrome (AIDS)
Adopting different age specific Voluntary Medical Male circumcision (VMMC) scale up strategies result in varied impacts on population levels of HIV incidence over the short and long terms
Efficiency in this analysis is defined as the number of circumcisions that would need to be performed in order to avert one HIV infection

Summary

Introduction

A country of just 2.5 million people, Namibia has made progress over the past decade in reducing the spread of the human immunodeficiency virus (HIV) and death from acquired immune deficiency syndrome (AIDS). Despite these efforts, HIV prevalence in Namibia is still. Several factors have been suggested as possible drivers of the high HIV prevalence including: multiple and concurrent partnerships; intergenerational sex; alcohol use; low condom use; transactional sex, population mobility; early age at sexual initiation and, central to this analysis, low coverage of male circumcision [2,3,4,5]. There is a rapid rate of partner turnover among sexually active Namibians, especially male youths [6, 7]

Methods

Results

Discussion

Conclusion