Background: VMMC is a large-scale HIV prevention intervention implemented primarily in 14 southern and eastern African countries, with over 22 million circumcisions performed following WHO and UNAIDS recommendations in 2007. VMMC has provided millions of men with lifelong 60% lower risk of HIV infection, and also provides their female partners with health benefits including decreased risk for human papillomavirus (HPV) and resultant cervical cancer (CC). We modeled the potential impact of VMMC on CC incidence and mortality as an additional benefit beyond HIV prevention.
Methods: We used a simulation-based Spectrum cervical cancer and HPV optimization model calibrated for Uganda to estimate HPV infection incidence over 50 years (2018-2067), based on the gradual nature of malignant transformation. 2016 Demographic Health Survey data provided baseline VMMC coverage. Assumptions included VMMC scale-up to 90% coverage in all age groups 15-49 by 2023; 2018 Uganda-specific HPV epidemiologic estimates from the WHO-affiliated HPV Information Centre including CC crude rate 28.8 per 100,000 and HPV 16/18 prevalence 3.6%; and circumcision effects from published literature - 53% reduction in acquisition rate of high-risk HPV types and 56% increase in clearance rates among HIV-negative men, and no impact among HIV-positive men. The baseline (no VMMC scale-up beyond current levels) was compared to multiple scenarios to assess the impact of VMMC scale-up in the absence of HPV vaccination and CC screening programs.
Results: In a scenario where coverage of all interventions remain at current levels, the crude CC incidence and mortality rates are 32.8 and 17.3 per 100,000 women per year, respectively, in 2067. VMMC scale-up decreases CC incidence to 26.6 by 2067 and averts 14,000 deaths between 2018-2067. In the presence of 90% HPV vaccination coverage for adolescent girls and young women, incidence drops below 10 per 100,000 with or without a VMMC program.
Conclusions: Planned VMMC scale-up to 90% coverage from current levels can prevent a substantial number of CC cases without dedicated HPV and CC interventions, though it adds little in settings where these are in place. Further modeling is needed to determine potential region-wide CC and CC-related mortality prevention benefits of VMMC and those experienced from circumcisions already done.

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