Voluntary Medical Male Circumcision (VMMC) – a cost-effective HIV prevention measure in eastern and southern Africa: a UNAIDS and PEPFAR collection

Editor’s note: Earlier this week, PLoS Medicine announced the publication of a sponsored Collection, in conjunction with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)Voluntary Medical Male Circumcision for HIV Prevention: The Cost, Impact, and Challenges of Accelerated Scale-Up in Southern and Eastern Africa. In addition to containing research articles and reviews from PLoS Medicine, this Collection also contains a few PLoS ONE manuscripts.  The following post explains this Collection and was originally posted on PLoS Medicine’s blog, Speaking of Medicine. It was written by Sumrina Yousufzai, a Publications Manager who works for PLoS Medicine.

The Collection comprises four reviews and five research articles, and highlights how scaling up voluntary medical male circumcision (VMMC) for HIV prevention in eastern and southern Africa can help prevent HIV, not only at the individual level but also at the community and population level, as well as leading to substantial cost savings for countries due to averted treatment and care costs. Two of the research articles are published in PLoS ONE; the remaining seven articles are published in PLoS Medicine on 29th November 2011. They can be accessed from the PLoS Medicine VMMC Collection page; the table of contents is also included below.

The first article by Catherine Hankins of UNAIDS, Steven Forsythe of The Futures Institute, and Emmanuel Njeuhmeli of PEPFAR/USAID, offers an introduction to the cost, impact and challenges of accelerated scaling up and lays out the rationale for the Collection. The remaining eight papers focus on the various factors that have important roles in effective program expansion of VMMC, including data for decision making, policy and programmatic frameworks, logistics, demand creation, human resources, and translating research into services.

The potential cost savings of scale-up are clear. An initial investment of US$1.5 billion between 2011 and 2015 to achieve 80% coverage of VMMC services in 14 priority countries in southern and eastern Africa, and thereafter US$0.5 billion between 2016 and 2025 to maintain coverage of 80%, could result in net savings of US$16.5 billion between 2011 and 2025. However, as the articles in the Collection show, strong political leadership, country ownership, and stakeholder engagement, along with effective demand creation, community mobilization and human resource deployment, are essential for effectively expanding and maintaining VMMC programs.

All 9 articles were peer-reviewed, revised and considered in depth by the editorial team, and subjected to all the usual PLoS Medicine or PLoS ONE editorial processes. We would like to thank the numerous peer reviewers for their detailed critiques, which helped to shape the articles, and we would also like to thank the authors for their patience in making appropriate revisions to these reviews. In particular we would like to Stephanie Sansom, guest academic editor, who read all the articles and provided critical feedback and reviewer advice to the editorial team. A special thank you goes to Emmanuel Njeuhmeli of PEPFAR/USAID who served as the main editorial contact for the articles in this Collection.

A question-and-answer Twitter expert session [#VMMC@USAIDGH] will be held on December 19 2011, from 1pm-2pm EST, with Emmanuel Njeuhmeli, Senior Biomedical Prevention Advisor of the Office of HIV/AIDS/USAID Washington, Co-Chair PEPFAR, Male Circumcision Technical Working Group, and an author on several of the articles in the Collection. In regard to this Collection Dr. Njeuhmeli comments:

“The collaboration that led to the findings in the PLoS Collection is a true testament to what international partners can accomplish when they work together and do so effectively to support country strategy for HIV Prevention. I can say with confidence this collaboration has played a major role in moving the needle on VMMC and HIV prevention. This Collection represents extensive collaboration between Ministries of Health, WHO, UNAIDS, PEPFAR and implementing partners to document and share with policy makers and program implementers the estimated cost and potential impact of scaling up voluntary medical male circumcision (VMMC) services in southern and eastern Africa. The papers included in this Collection document the enormous potential of VMMC to alter the course of the epidemic. They also describe the way that country programs have successfully navigated human resource, demand generation and other challenges in an effort to rapidly scale up comprehensive VMMC services.”

Collection Table of Contents :

1)     Voluntary Medical Male Circumcision: An Introduction to the Cost, Impact, and Challenges of Accelerated Scaling Up

2)     Voluntary Medical Male Circumcision: Modeling the Impact and Cost of Expanding Male Circumcision for HIV Prevention in Eastern and Southern Africa

3)     Voluntary Medical Male Circumcision: A Framework Analysis of Policy and Program Implementation in Eastern and Southern Africa

4)     Voluntary Medical Male Circumcision: A Cross-Sectional Study Comparing Circumcision Self-Report and Physical Examination Findings in Lesotho

5)     Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services

6)     Voluntary Medical Male Circumcision: A Qualitative Study Exploring the Challenges of Costing Demand Creation in Eastern and Southern Africa

7)     Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa

8)     Voluntary Medical Male Circumcision: Translating Research into the Rapid Expansion of Services in Kenya, 2008–2011

9)      Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

Disclaimer: The views expressed in the VMMC collection are those of the authors and do not necessarily reflect the official policy or position of the U.S. Government and UNAIDS. The collection was produced with support from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). The PLoS Medicine editors have sole editorial responsibility for the content of this collection.

Image Credit: PEPFAR Male Circumcision Technical Working Group

Permission to use the CCAL license granted by the PEPFAR Male Circumcision Technical Working Group.

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3 Responses to Voluntary Medical Male Circumcision (VMMC) – a cost-effective HIV prevention measure in eastern and southern Africa: a UNAIDS and PEPFAR collection

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  3. Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. Authorities that cite the studies have other agendas. Circumcision causes physical, sexual, and psychological harm. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Please see http://www.circumcision.org/hiv.htm for more information.

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