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<p>Totals reflect progress through 2012. Percentage figures represent the achieved proportion of the target of 80% coverage among males ages 15–49, but totals include circumcisions done for all age groups, regardless of the age-range target. Data obtained from WHO 2012 VMMC report <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001641#pmed.1001641-WHOAFRO1" target="_blank">[38]</a>.</p

Scale-up of voluntary medical male circumcision program and coverage in 14 priority countries, aggregate, 2008–2013.

<p>Number of circumcisions completed each year in millions. Source of 2008–2012 data is the WHO 2012 VMMC report <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001641#pmed.1001641-WHOAFRO1" target="_blank">[38]</a>. 2013 numbers have been estimated using data from PEPFAR and the Bill & Melinda Gates Foundation. *CAGR, compound annual growth rate, calculated based on the average proportional growth each year. CAGR (t₀,t_n)  =  (V(t_n)/V(t₀))^{1/(tn − to)} −1, where V(t₀) is the start value and V(t_n) is the finish value and t_n − t₀ is the number of years.</p

Timeline and key milestones of the voluntary medical male circumcision program in 14 priority countries.

<p>6 million circumcisions listed in 2013 is an estimate by PEPFAR and the Bill & Melinda Gates Foundation. RCTs, randomized controlled trials; TWG, technical working group; TAG, technical advisory group; MOVE, Models for Optimizing the Volume and Efficiency of MC services.</p

Feasibility and time required to achieve 1.95 million voluntary medical male circumcisions (VMMCs) among 15–49 year old males through two forecast scenarios.

<p>The cumulative number of VMMCs for two different projections based on the current roll-out of the VMMC program (<i>forecast plan based on no-growth scale-up</i> scenario and <i>forecast plan based on current VMMC program scale-up</i> scenario). These projections are compared to the original Zambia VMMC program scale-up plan.</p

Sensitivity analyses on predictions of intervention outcomes.

<p><b>A</b>) Sensitivity of model-predicted intervention effectiveness to antiretroviral therapy (ART) coverage scale-up over the coming decades. The sensitivity analysis compares effectiveness with and without mass ART scale-up for different age-group prioritizations. <b>B)</b> Sensitivity of model-predicted intervention effectiveness to sexual risk compensation with VMMC. The sensitivity analysis is conducted by comparing the effectiveness at six different levels of risk compensation, starting with 0% risk compensation, by targeting the 15–49 age bracket.</p

Projected outcomes of geographic and risk-group prioritization.

<p><b>A)</b> Number of voluntary medical male circumcisions (VMMCs) needed to avert one HIV infection (<i>effectiveness</i>) by 2025 through geographic prioritization. <b>B)</b> Expansion path curve showing the incremental increase in total cost of the VMMC program relative to total number of HIV infections averted (<i>magnitude of impact</i>) for each geographic targeted intervention. <b>C)</b> Number of VMMCs needed to avert one HIV infection by 2025 through risk-group prioritization. <b>D)</b> Expansion path curve showing the incremental increase in total cost of the VMMC program relative to total number of HIV infections averted for each risk-group targeted intervention. In both <b>B</b> and <b>D</b>, the blue line describes the expansion of the program with minimal diminishing of returns and the red line describes the expansion of the program with considerable diminishing of returns.</p

Projected outcomes of age-group prioritization.

<p><b>A)</b> Number of voluntary medical male circumcisions (VMMCs) needed to avert one HIV infection (<i>effectiveness</i>) by 2025. <b>B)</b> Cost per HIV infection averted by 2025 (<i>cost-effectiveness</i>). <b>C)</b> Proportion of incidence rate reduction in the total adult population throughout the years up to 2045. <b>D)</b> Proportion of incidence rate reduction in the female adult population throughout the years up to 2045. The results are for 80% VMMC coverage by 2017 in the prioritized age group.</p

Program efficiency and policy domains of age-group prioritization in the voluntary medical male circumcision (VMMC) program.

<p><b>A)</b> Expansion path curve showing the incremental increase in total cost of the VMMC program relative to total number of HIV infections averted (<i>magnitude of impact</i>) for each age-group targeted intervention. The blue line describes the expansion of the program with minimal diminishing of returns and the red line describes the expansion of the program with considerable diminishing of returns. <b>B)</b> Frontier-policy plot classifying the different policy domains based on the theme of maximizing program efficiency (maximizing gain while minimizing cost). Circle size represents the magnitude of the impact. <b>C)</b> Frontier-policy plot delineating the different policy domains based on the theme of maximizing the total impact of the VMMC program. Circle size here represents the total number of VMMCs needed relative to the baseline VMMC intervention scenario. In both <b>B</b> and <b>C</b>, the orange circles represent the age brackets that fall within the optimal policy domain and the blue circle represents the baseline VMMC intervention scenario.</p

Effectiveness of the VMMC program in Zambia under different VMMC intervention scenarios.

<p>Effectiveness of the VMMC program in Zambia under different VMMC intervention scenarios.</p

Impact of different male circumcision efficacy levels, against male-to-female HIV transmission, on HIV incidence rate reduction in Zambia.

<p>Incidence rate reduction in <b>A)</b> the female population and in <b>B)</b> the male population with the VMMC program including a proportion of HIV-positive males, based on their representation in the population. The panels assume <i>i</i>) 0% efficacy, <i>ii</i>) 20% efficacy, and <i>iii</i>) 46% efficacy of male circumcision against male-to-female HIV transmission.</p