Circumcising newborn males is a cost effective strategy for HIV prevention in Rwanda
19-Jan-2010 - Circumcising newborn boys as a way to prevent HIV infection in later life is more cost-effective than
circumcising adult males, finds a new Rwandan study in this week's PLoS Medicine.
It has already been conclusively shown, from three randomized clinical trials in Uganda, Kenya, and South Africa, that
adult male circumcision (MC) roughly halves the HIV transmission rate from women to men. Many African countries hit hard by HIV are therefore
offering men the procedure as way to control the epidemic. Rwanda is one such country- about 3% of adults in Rwanda are infected with HIV
but only 15% of men are currently circumcised.
But performing the operation in adolescents and adults is linked with a higher risk of complications than circumcising
newborns. And the operation is quicker and simpler to perform in newborns. The new study, by Agnes Binagwaho (Rwanda Ministry of Health) and
colleagues, therefore set out to compare three different strategies as applied to Rwanda: circumcising newborns (neonates), adolescents, or adults.
The researchers used a technique called "cost-effective analysis," which looks at the balance between the costs of a medical
intervention and its benefits. They estimated that each neonatal MC would cost just US$15 whereas each adolescent or adult MC would cost US$59. They
found that neonatal MC would in fact save more money than it costs, because the operation is cheap to perform and would prevent HIV infections
that are expensive to treat.
The study findings, say the authors, "suggest that Rwanda should be simultaneously scaling up circumcision across a broad range of age groups,
with high priority to the very young."
In an expert commentary on the new study, Seth Kalichman (University of Connecticut) says: "The cost-savings of neonatal MC are compelling
and suggest that implementation is economically feasible in developing countries hit hardest by HIV/AIDS. Neonatal MC should therefore be
considered a priority in comprehensive HIV prevention plans for southern Africa."
Funding: No specific funding was received for the writing of this piece.
Competing Interests: Agnes Binagwaho is an Editorial Board member of PLoS Medicine .
Citation: Binagwaho A, Pegurri E, Muita J, Bertozzi S (2010) Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study. PLoS Med 7(1): e1000211. doi:10.1371/journal.pmed.1000211
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Related PLoS Medicine Perspective by Seth Kalichman:
Funding:National Institute of Mental Health (NIMH) Grant RO1-MH74371 and National Institute of Alcohol Abuse and Alcoholism (NIAAA) Grant RC1AA018983 supported this paper. The funders had no role in the decision
to publish or preparation of the manuscript.
Competing Interests: The author has declared that no competing interests exist.
Citation: Kalichman SC (2010) Neonatal Circumcision for HIV Prevention: Cost, Culture, and Behavioral Considerations. PLoS Med 7(1): e1000219. doi:10.1371/journal.pmed.1000219
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