2. Modeling the Impact and Cost of Age and Regional Targeting for Voluntary Medical Male Circumcision Scale-up MOAC0203 and MOAC0204 Presented by Emmanuel Njeuhmeli, USAID for Katharine Kripke, Avenir Health, Health Policy Project and Project SOAR ICASA 2015 30 November, 2015

3. Introduction

4. PEPFAR UNAIDS VMMC PLoS Medicine Collection published 29 November 2011

5. New Modeling Questions Which age groups show promise of having the greatest impact on the HIV epidemic? How much does circumcising older men contribute to decreasing HIV infections? What is the impact on HIV incidence of circumcising males ages 10–14 (adolescents)? Would it be advisable to prioritize certain regions of a given country? Impact, cost-effectiveness, targets New Model DMPPT cannot be used for this analysis because it is set up to compare only three age ranges (EIMC, 15–24, and 25–49)—not the full set of ranges we want to consider. Also, the DMPPT only projects through 2025. DMPPT 2: Simple spreadsheet model prepared by Avenir Health (formerly Futures Institute) under PEPFAR, through the USAID-funded Health Policy Project It can be taken to the country level as a tool to assist with target setting and coverage estimates at the national and subnational levels

6. So Far… Country applications in: Malawi, South Africa, Swaziland, Tanzania, Uganda All five countries have used results to inform VMMC policy, strategy, and/or operational plan PEPFAR used results to inform 2015 COP technical guidance RE VMMC targets Bill and Melinda Gates Foundation conducted a similar exercise in Zambia and Zimbabwe, using a different model Plans are underway to apply the DMPPT 2.1 model in Kenya, Lesotho, Mozambique, and Namibia in 2016

7. Age Prioritization Analyses from Swaziland and Uganda

8. Age Distribution of Actual Clients vs. Potential Clients UgandaSwaziland

9. Scale-up and Maintenance Phase for Reaching 80% MC Coverage Among Males Ages 10–34 by 2018, Uganda

10. How Impact on HIV Incidence Changes over Time when Circumcising Different Age Groups SwazilandUganda

11. VMMC Impact and Program Cost Uganda Swaziland

12. Indicator MalawiSouth AfricaSwazilandTanzaniaUganda Number of VMMC/HIV infections averted (15 years) 20-34 15-3420-34 Immediacy of Impact (5 years) 20-34 15-34 Magnitude of Impact (15 years) 15-24 15-2910-2410-19 Cost-effectiveness (15 years) 15-34 Priority age groups for each parameter in the model framework

13. Regional Analyses from Uganda

14. Discounted Cost/Infection Averted, 2013– 2028

15. VMMC Program in Uganda is Cost- saving in All Regions

16. Acknowledgements This work was funded by PEPFAR through USAID under the Health Policy Project (HPP) and Project SOAR Analyses conducted and slides prepared by Katharine Kripke, Avenir Health (formerly Futures Institute), and Melissa Schnure, Palladium (formerly Futures Group), under HPP and Project SOAR The DMPPT 2.0 model was developed by John Stover, Avenir Health, under HPP Updates to the DMPPT 2.1 model for the progress assessment were performed by Matthew Hamilton, Avenir Health, under HPP and Project SOAR Uganda modeling Wilford Kirungi, Ministry of Health Mercy Maybo, Rhobbinah Ssempebwa, Sheila Kyobutungi, Estella Birabwa, and Suzan Nakawunde, USAID/Uganda Monica Dea, CDC/Uganda Swaziland modeling Vusi Maziya, Ministry of Health Munamato Mirira and Wendy Benzerga, USAID/Swaziland