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Voluntary medical male circumcision (VMMC) reduces the risk of male HIVacquisition by 60%. Programmes to provide male circumcision (MC) to prevent HIVinfection have been introduced in sub-Saharan African countries with high HIVburden. While large-scale provision of MMC is recent, traditional MC has longbeen conducted as part of male coming-of-age practices. How and at what agetraditional MC occurs varies by ethnic groups within countries. Accurateestimates of MC coverage by age and type of circumcision (traditional ormedical) over time at sub-national levels are essential for planning anddelivering VMMCs to meet targets and evaluating their impacts on HIV incidence.In this paper, we developed a Bayesian competing risks time-to-event model toproduce region-age-time-type specific probabilities and coverage of MC withprobabilistic uncertainty. The model jointly synthesises data from householdsurveys and health system data on the number of VMMCs conducted. Wedemonstrated the model using data from five household surveys and VMMCprogramme data to produce estimates of MC coverage for 52 districts in SouthAfrica between 2008 and 2019. Nationally in 2008, 24.1% (CI: 23.4-24.8%) of menaged 15-49 were traditionally circumcised and 19.4% (CI: 18.9-20.0%) weremedically circumcised. Between 2008 and 2019, five million VMMCs wereconducted, and MC coverage among men aged 15-49 increased to 64.0% (CI:63.2-64.9%) and medical MC coverage to 42% (CI: 41.3-43.0%). MC coverage variedwidely across districts, ranging from 13.4-86.3%. The average age oftraditional MC ranged between 13 to 19 years, depending on local culturalpractices.

A multi-level model for estimating region-age-time-type specific male  circumcision coverage from household survey and health system data in South  Africa