TY - JOUR
T1 - To cut or not to cut
T2 - A modeling approach for assessing the role of male circumcision in HIV control
AU - Podder, C. N.
AU - Sharomi, O.
AU - Gumel, A. B.
AU - Moses, S.
N1 - Funding Information:
A.B.G. acknowledges, with thanks, the support in part of the Natural Science and Engineering Research Council (NSERC) and Mathematics of Information Technology and Complex Systems (MITACS) of Canada. C.N.P. and O.S. gratefully acknowledge the support of the Institute of Industrial Mathematical Sciences and the Department of Mathematics, University of Manitoba. The authors are grateful to the three anonymous reviewers for their valuable comments which have enhanced the paper.
PY - 2007/11
Y1 - 2007/11
N2 - A recent randomized controlled trial shows a significant reduction in women-to-men transmission of HIV due to male circumcision. Such development calls for a rigorous mathematical study to ascertain the full impact of male circumcision in reducing HIV burden, especially in resource-poor nations where access to anti-retroviral drugs is limited. First of all, this paper presents a compartmental model for the transmission dynamics of HIV in a community where male circumcision is practiced. In addition to having a disease-free equilibrium, which is locally-asymptotically stable whenever a certain epidemiological threshold is less than unity, the model exhibits the phenomenon of backward bifurcation, where the disease-free equilibrium coexists with a stable endemic equilibrium when the threshold is less than unity. The implication of this result is that HIV may persist in the population even when the reproduction threshold is less than unity. Using partial data from South Africa, the study shows that male circumcision at 60% efficacy level can prevent up to 220,000 cases and 8,200 deaths in the country within a year. Further, it is shown that male circumcision can significantly reduce, but not eliminate, HIV burden in a community. However, disease elimination is feasible if male circumcision is combined with other interventions such as ARVs and condom use. It is shown that the combined use of male circumcision and ARVs is more effective in reducing disease burden than the combined use of male circumcision and condoms for a moderate condom compliance rate.
AB - A recent randomized controlled trial shows a significant reduction in women-to-men transmission of HIV due to male circumcision. Such development calls for a rigorous mathematical study to ascertain the full impact of male circumcision in reducing HIV burden, especially in resource-poor nations where access to anti-retroviral drugs is limited. First of all, this paper presents a compartmental model for the transmission dynamics of HIV in a community where male circumcision is practiced. In addition to having a disease-free equilibrium, which is locally-asymptotically stable whenever a certain epidemiological threshold is less than unity, the model exhibits the phenomenon of backward bifurcation, where the disease-free equilibrium coexists with a stable endemic equilibrium when the threshold is less than unity. The implication of this result is that HIV may persist in the population even when the reproduction threshold is less than unity. Using partial data from South Africa, the study shows that male circumcision at 60% efficacy level can prevent up to 220,000 cases and 8,200 deaths in the country within a year. Further, it is shown that male circumcision can significantly reduce, but not eliminate, HIV burden in a community. However, disease elimination is feasible if male circumcision is combined with other interventions such as ARVs and condom use. It is shown that the combined use of male circumcision and ARVs is more effective in reducing disease burden than the combined use of male circumcision and condoms for a moderate condom compliance rate.
KW - ARVs
KW - Backward bifurcation
KW - Condoms
KW - HIV/AIDS
KW - Male circumcision
KW - Reproduction number
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U2 - 10.1007/s11538-007-9226-9
DO - 10.1007/s11538-007-9226-9
M3 - Article
C2 - 17557187
AN - SCOPUS:35648941691
SN - 0092-8240
VL - 69
SP - 2447
EP - 2466
JO - Bulletin of mathematical biology
JF - Bulletin of mathematical biology
IS - 8
ER -