15th Conference on Retroviruses and Opportunistic Infections Boston, Massachusetts - February 3-6, 2008

Conf Retrovir Opportunistic Infect 2008 Feb 3-6;15: (abstract no. 2)

Bertran Auvert¹, E Marseille², and J Kahn^2
1INSERM U687, Univ of Versailles, and Hosp Ambroise Pare, France and ²Philip R Lee Inst for Hlth Policy Studies, Univ of California, San Francisco, US

BACKGROUND: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%, and may avert 2 million to 8 million HIV infections over 20 years in Sub-Saharan Africa, and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll-out MAMC and the net savings due to reduced infections.

METHODS: We develop a model, which includes costing, demography, and HIV epidemiology. We use it to investigate the 14 countries in Sub-Saharan Africa where the prevalence of male circumcision is <80% and HIV prevalence among adults is >5%, Uganda, and Nyanza province in Kenya. We assume that 85% of uncircumcised men will accept MAMC, and that surgery is done as it was in the trials. Outcomes include program cost, number of full-time circumcisers, and net cost or saving when adjusted for averted HIV treatments. Costs are in US dollars, discounted to 2007; 95% percentile intervals (95% PI) were estimated by Monte Carlo simulation.

RESULTS: The number of circumcisers needed was 2357 (95% PI 2070 to 3061), equal to 0.25 (95% PI 0.22 to 0.32) per 10 000 adults. In years 6 to 10, the number of circumcisers needed fell to 626 (95% PI 533 to 861). The estimated 5-year cost of rolling out MAMC sector was $965 million (95% PI 763 to 1301). The cumulative net cost over the first 10 years was $536 million (95% PI 253 to 901), and over 20 years there were net savings of $3.9 billion (95% PI 2.6 to 5.4).

CONCLUSIONS: A rapid roll-out of MAMC in Sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first 5 years. These investments are justified by MAMC’s substantial health benefits and the savings that accrue by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability.

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2008-02-3
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