Voluntary Medical Male Circumcision: Introduction to the Cost, Impact, and Challenges of Accelerated Scaling Up International Conference on AIDS and Sexually Transmitted Infections in Africa, Addis Ababa, December 3, 2011 Hankins C, Forsythe S, Njeuhmeli E 1 UNAIDS, 2 Futures Institute, 3 USAID

Scientific Evidence: Male Circumcision Reduces HIV Risk Decades of ecological and observational evidence: lack of male circumcision/higher HIV prevalence Randomised controlled trials in Kenya, Uganda, and South Africa stopped early: compelling trial evidence that medical male circumcision confers almost 60% protection Protective effect sustained/increased: Longer-term (4-5 years) follow-up of trial participants in Kenya and Uganda Community level impact evaluation in South Africa (Orange Farm) shows reduced HIV prevalence and incidence in circumcised men

Introduction to the cost, impact, and challenges of accelerated scaling up in eastern and southern Africa Modelling the impact and cost of expanding male circumcision for HIV prevention Framework analysis of policy and program implementation Comparing circumcision self-report and physical examination in Lesotho Logistics, commodities, and waste management requirements Challenges of costing demand creation Meeting the human resource needs of scale-up Translating research into rapid expansion of services in Kenya Iringa, Tanzania: matching demand and supply with quality and efficiency in a high-volume setting Nine papers in PLoS VMMC Collection

Priority Countries for VMMC Scale-up

Key points to retain Scaling up VMMC for HIV prevention is cost saving and creates fiscal space in the future that otherwise would have been encumbered by antiretroviral treatment costs An investment of US$1.5 billon between 2011 and 2015 to achieve 80% coverage in 13 priority countries in southern and eastern Africa will: avert 3.4 million HIV infections by 2025 result in net savings of US$16.5 billion by 2025

Number and % infections averted to 2025 by scale-up to 80% coverage by 2015

Marking progress: From historical levels of male circumcision to 80% coverage: Achievement in 14 priority countries

Key points to retain This collection of articles on determining the cost and impact of VMMC for HIV prevention signposts the way forward to scaling up VMMC service delivery safely and efficiently to reap individual- and population-level benefits What is needed? Strong political leadership, country ownership, and stakeholder engagement, along with effective: demand creation community mobilisation commodities, supply chain and waste management human resource deployment

Thank You For further information, please visit: PLoS Medicine VMMC Collection: For this manuscript: Voluntary medical male circumcision: An introduction to the cost, impact, and challenges of accelerated scaling up: 1%2Fjournal.pmed %2Fjournal.pmed