Scale-Up of Voluntary Medical Male Circumcisions as Part of Combination HIV Prevention Strategies – Mozambique, 2010-2023

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Abstract Introduction Voluntary Medical Male Circumcision (VMMC) is a cost-effective HIV prevention strategy, reducing risk of female-to-male transmission by approximately 60%. Mozambique implemented a national VMMC program since 2010, including HIV testing to identify HIV positive men. We used program data to describe the President’s Emergency Plan for AIDS Relief (PEPFAR)-supported VMMC services in seven provinces in Mozambique. Methods We analyzed aggregate PEPFAR Monitoring, Evaluation, and Reporting data for 2010–2023 for VMMCs conducted and HIV testing at VMMC sites. VMMC coverage rate was calculated as the number of males who reported medical or traditional circumcisions over the estimated population. Test positivity rate was calculated as positive tests over the total tests conducted. Data were analyzed by fiscal year (October–September), age group (<15 years, 15–29 years, ≥30 years), and province. Results During 2010-2023 total 2,534,411 VMMCs were performed, of which, 1,032,789 (41%) among boys <15 years old, 1,368,582 (54%) among men aged 15– 29, and 133,039 (5%), men aged >30. By 2023, national VMMC coverage was 77% (higher among men aged 20–24 years, at 80%). Overall HIV test positivity rate was 1.6% (35,743 positives), with a provincial range of 0.4% to 5.9%. Older men aged 45-49 had higher HIV positivity rate of 24.3%. Conclusion VMMC implementation during twelve years reached priority boys and men aged 15-29 for immediate impact on HIV prevention. Essentially, program has circumcised a large amount of boys and men, leading to higher VMMC coverage and anticipated reductions in HIV transmission. Further, services have helped identify men already living with HIV.

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