The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

Background: South Africa began offering medical male circumcision (MMC) in
2010. We evaluated the current and future impact of this program to see if
it is effective in preventing new HIV infections. Methods: The Thembisa,
Goals and EMOD HIV transmission models were calibrated to South Africa’s
HIV epidemic, fitting to household survey data on HIV prevalence, risk
behaviors, and proportions of men circumcised, and to programmatic data on
intervention roll-out including program-reported MMCs over 2009-2017. We
compared the actual program accomplishments through 2017 and program
targets through 2021 with a counterfactual scenario of no MMC program.
Results: The MMC program averted 71,000-83,000 new HIV infections from
2010 to 2017. The future benefit of the circumcision already conducted
will grow to 496,000-518,000 infections (6-7% of all new infections) by
2030. If program targets are met by 2021 the benefits will increase to
723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220
per infection averted relative to no MMC. The savings from averted
treatment needs would become larger than the costs of the MMC program
around 2034-2039. In the Thembisa model, when modelling South Africa’s 9
provinces individually, the 9-provinces-aggregate results were similar to
those of the single national model. Across provinces, projected long-term
impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27%
reduction over 2017-2030), reflecting these provinces’ greater MMC
scale-up. Conclusions: MMC has already had a modest impact on HIV
incidence in South Africa and can substantially impact South Africa’s HIV
epidemic in the coming years.