Table 1. Definitions of outcome measures in the three-level conceptual framework.

Measure	Definition
Level 1
Effectiveness of VMMC	Total number of VMMCs per HIV infection averted
Cost-effectiveness of VMMC	Cost per HIV infection averted
Scale of reduction in the risk of HIV exposure	HIV incidence rate reduction
Magnitude of impact	Total number of HIV infections averted over a given time period
Total VMMC program cost	Total cost of the VMMC program
Level 2
Expansion path curve	Examines the incremental change in total VMMC program cost relative to the incremental change in total number of HIV infections averted
Program efficiency policy frontier plot	Delineates the different possible policy domains based on the theme of maximizing program efficiency (maximizing gain while minimizing pain, Gain/Pain index*)
Total impact policy frontier plot	Delineates the different possible policy domains based on the theme of maximizing the total impact of the VMMC program (number of HIV infections averted)
Level 3
Programmatic feasibility	Feasibility based on on-the-ground country experiences

Voluntary medical male circumcision (VMMC) program scenarios are assessed based on epidemiological and health economics measures (Level 1), program efficiency and policy outcome measures (Level 2), and programmatic feasibility (Level 3).

* Gain/Pain index: the proportional reduction in the total number of infections averted (Gain) over the proportional reduction in the total VMMC program cost (Pain). These proportions are assessed relative to the baseline scenario of targeting males aged 15–49 years.