ArticleThe Lancet. Global health2023
Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Economic value of international missions and domestic initiatives to strengthen surgical care in low- and middle-income countries: systematic review.The British journal of surgery · 2025Pooled it
- Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa.PloS one · 2023Trial
- Trends in age at male circumcision and its determinants in Rwanda.AIDS research and therapy · 2026Article
- Exploring psychological experiences of soldiers who have undergone voluntary male medical circumcision at the Engineers Battalion in Kasungu, Malawi.Health SA = SA Gesondheid · 2026Article
- Health worker perspectives on, and health system-level facilitators and barriers to early infant male circumcision for HIV prevention in a traditionally non-circumcising community, Northeastern Uganda: a cross-sectional qualitative study.BMC health services research · 2025Article
- Understanding stakeholder perspectives on integrating and sustaining a vertical HIV prevention programme into routine health services in Zimbabwe: a qualitative study.BMJ global health · 2025Article
- Uncovering the impact of randomness in HIV hotspot formation: A mathematical modeling study.PLoS computational biology · 2025Article
- The changing cost-effectiveness of primary HIV prevention: simple calculations of direct effects.Journal of the International AIDS Society · 2025Article
- A modified Shang Ring circumcision surgical technique under local anesthesia for penile torsion in children.Translational andrology and urology · 2025Article
- A comparative analysis of voluntary medical male circumcision before and during the COVID-19 pandemic in Gauteng province, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2025Article
- Integration of a vertical voluntary medical male circumcision program into routine health services in Zimbabwe: A solution for sustainable HIV prevention.PLOS global public health · 2025Article
- Ethics of Mathematical Modeling in Public Health: The Case of Medical Male Circumcision for HIV Prevention in Africa.Public health ethics · 2024Article
- Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study.BMC public health · 2024Article
- Article
- Dissemination and implementation of an evidence-based voluntary medical male circumcision program: The Spear & Shield program.PLOS global public health · 2024Article
- Shifting reasons for older men remaining uncircumcised: Findings from a pre- and post-demand creation intervention among men aged 25-39 years in western Kenya.PLOS global public health · 2024Article
- Using economic analysis to inform health resource allocation: lessons from Malawi.Discover health systems · 2024Review
- Male circumcision uptake and misperceived norms about male circumcision: Cross-sectional, population-based study in rural Uganda.Journal of global health · 2023Article
- A quantitative assessment of the consistency of projections from five mathematical models of the HIV epidemic in South Africa: a model comparison study.BMC public health · 2023Article
- Defining the Global Research and Programmatic Agenda and Priority Actions for Voluntary Medical Male Circumcision for HIV Prevention.Current HIV/AIDS reports · 2022Review
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
30 authors at 17 institutions in 7 countries.
Funding
Abstract
backgroundVoluntary medical male circumcision (VMMC) has been a recommended HIV prevention strategy in sub-Saharan Africa since 2007, particularly in countries with high HIV prevalence. However, given the scale-up of antiretroviral therapy programmes, it is not clear whether VMMC still represents a cost-effective use of scarce HIV programme resources.
methodsUsing five existing well described HIV mathematical models, we compared continuation of VMMC for 5 years in men aged 15 years and older to no further VMMC in South Africa, Malawi, and Zimbabwe and across a range of setting scenarios in sub-Saharan Africa. Outputs were based on a 50-year time horizon, VMMC cost was assumed to be US$90, and a cost-effectiveness threshold of US$500 was used.
findingsIn South Africa and Malawi, the continuation of VMMC for 5 years resulted in cost savings and health benefits (infections and disability-adjusted life-years averted) according to all models. Of the two models modelling Zimbabwe, the continuation of VMMC for 5 years resulted in cost savings and health benefits by one model but was not as cost-effective according to the other model. Continuation of VMMC was cost-effective in 68% of setting scenarios across sub-Saharan Africa. VMMC was more likely to be cost-effective in modelled settings with higher HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 0·1 per 100 person-years in men aged 15-49 years, increasing to 95% with HIV incidence greater than 1·0 per 100 person-years.
interpretationVMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years.
fundingBill & Melinda Gates Foundation for the HIV Modelling Consortium.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.