A collection of nine new articles to be published in PLoS Medicine and PLoS ONE, in conjunction with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President's Emergency Plan for AIDS Relief (PEPFAR), highlights how scaling up voluntary medical male circumcision (VMMC) for HIV prevention in eastern and southern Africa can help prevent HIV not only at individual but also at community and population level as well as lead to substantial cost savings for countries due to averted treatment and care costs.
The first article by Catherine Hankins of UNAIDS, Steven Forsythe of The Futures Institute, and Emmanuel Njeuhmeli of PEPFAR/USAID, offers an introduction to the cost, impact and challenges of accelerated scaling up and lays out the rationale for the series. This article, as well as the one to follow, signposts the way forward to accelerate the scaling up of VMMC service delivery safely and efficiently to reap individual-and population-level benefits.
The remaining 8 papers also focus on the various factors that go into effective program expansion of VMMC, including data for decision making, policy and programmatic frameworks, logistics, demand creation, human resources, and translating research into services.
The cost savings are clear: an initial investment of US$1.5 billion between 2011 and 2015 to achieve 80% coverage of VMMC services in 14 priority countries in southern and eastern Africa and thereafter US$0.5 billion between 2016 to 2025 to maintain that coverage of 80% would result in net savings of US$16.5 billion between 2011 and 2025. However, as the articles in the collection show, strong political leadership, country ownership, and stakeholder engagement, along with effective demand creation, community mobilisation, and human resource deployment, are essential in effectively expanding and maintaining VMMC programs.