VMMC is associated with an approximate 60 percent reduction in the risk of female-to-male transmission of HIV. Antiretroviral (ARV) treatment of the virus that results in a sustained undetectable viral load, also known as full viral suppression, likely virtually eliminates the risk of transmission according to recent studies.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has called for all nations to have 90 percent of their HIV populations diagnosed, 90 percent of that group on ARVs and 90 percent of that group at full viral suppression by 2020. This translates to an overall full viral suppression rate of 73 percent among a national HIV population. According to UNAIDS’s projections, reaching this so-called 90-90-90 goal would be instrumental in eliminating HIV as a major public health threat by 2030.
Publishing their findings in PLOS ONE, researchers used mathematical modeling to see how the scale-up of VMMC in Lesotho, Malawi, South Africa and Uganda would affect national HIV transmission rates in the context of the effort to reach the 90-90-90 targets. They modeled three scenarios, VMMC scale-up with: 1) the 90-90-90 targets met by 2020; 2) the first two points of the 90-90-90 targets met but the proportion of those on treatment with full viral suppression only at 75 percent (i.e., 90-90-75); and 3) the 90-90-90 targets met for women but with lesser treatment coverage for men.
In the context of meeting the 90-90-90 targets by 2020, getting 90 percent coverage of VMMC within five years would contribute to an additional, modest reduction of HIV transmission rates compared with achieving the 90-90-90 targets alone, driving them down to 0.05 percent to 0.5 percent of the national populations by 2050. This finding held true regardless of the initial HIV transmission or VMMC coverage rates.
If the treatment target met in each nation in 2020 were 90-90-75, 90 percent coverage of VMMC would also yield an additional modest reduction in HIV transmission rates, similar to if the full 90-90-90 targets were met. The same held true if the 90-90-90 target were met for women but not for men.
Scaling up VMMC increased the overall cost of driving down HIV rates compared with just scaling up diagnosis, treatment and improving viral suppression rates alone. However, by 2025, the addition of VMMC scale-up is linked to projected savings compared with just driving the 90-90-90 HIV diagnosis and treatment goals.
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