Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa.
Africa
Geospatial
Geostatistics
HIV
HIV prevention
Intervention
Male circumcision
Mapping
Medical male circumcision
Spatial statistics
Voluntary medical male circumcision
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
07 07 2020
07 07 2020
Historique:
received:
19
12
2019
accepted:
14
05
2020
entrez:
8
7
2020
pubmed:
8
7
2020
medline:
4
2
2021
Statut:
epublish
Résumé
HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50-60%. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15-49. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence. We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15-49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units. We found striking within-country and between-country variation in MC prevalence; most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas. Despite MC prevalence increases in all priority countries since the onset of VMMC campaigns in 2008, MC prevalence remains below the 80% coverage target in most subnational areas and is highly variable. These mapped results provide an actionable tool for understanding local needs and informing VMMC interventions for maximum impact in the continued effort towards ending the HIV epidemic in sub-Saharan Africa.
Sections du résumé
BACKGROUND
HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50-60%. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15-49. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence.
METHODS
We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15-49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units.
RESULTS
We found striking within-country and between-country variation in MC prevalence; most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas.
CONCLUSIONS
Despite MC prevalence increases in all priority countries since the onset of VMMC campaigns in 2008, MC prevalence remains below the 80% coverage target in most subnational areas and is highly variable. These mapped results provide an actionable tool for understanding local needs and informing VMMC interventions for maximum impact in the continued effort towards ending the HIV epidemic in sub-Saharan Africa.
Identifiants
pubmed: 32631314
doi: 10.1186/s12916-020-01635-5
pii: 10.1186/s12916-020-01635-5
pmc: PMC7339571
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
189Subventions
Organisme : Medical Research Council
ID : MR/R015600/1
Pays : United Kingdom
Organisme : Bill and Melinda Gates Foundation
ID : OPP1132415
Pays : International
Références
Bull World Health Organ. 2008 Sep;86(9):669-77
pubmed: 18797642
Glob Health Sci Pract. 2015 Sep 15;3(3):503-15
pubmed: 26374807
J Acquir Immune Defic Syndr. 2012 Aug 15;60 Suppl 3:S88-95
pubmed: 22797745
Medicine (Baltimore). 2017 Jan;96(2):e5885
pubmed: 28079830
Lancet Glob Health. 2019 Apr;7(4):e388-e389
pubmed: 30879496
Glob Public Health. 2015;10(5-6):639-66
pubmed: 25613581
PLoS Med. 2005 Nov;2(11):e298
pubmed: 16231970
Nature. 2018 Feb 28;555(7694):48-53
pubmed: 29493588
J Int AIDS Soc. 2011 Oct 20;14:49
pubmed: 22014096
J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):371-9
pubmed: 17558336
BMC Infect Dis. 2006 Nov 30;6:172
pubmed: 17137513
Front Public Health. 2015 Sep 29;3:218
pubmed: 26484339
AIDS. 2000 Oct 20;14(15):2361-70
pubmed: 11089625
PLoS One. 2016 Jul 13;11(7):e0156521
pubmed: 27410474
Bull World Health Organ. 2010 Dec 1;88(12):907-14
pubmed: 21124715
N Engl J Med. 2018 Sep 20;379(12):1128-1138
pubmed: 30231224
PLoS One. 2016 Jul 13;11(7):e0157071
pubmed: 27409079
BMC Public Health. 2016 Jan 05;16:7
pubmed: 26727935
Nature. 2019 Jun;570(7760):189-193
pubmed: 31092927
Popul Health Metr. 2016 Mar 01;14:4
pubmed: 26933388
PLoS One. 2011;6(11):e27561
pubmed: 22140449
Lancet HIV. 2016 Sep;3(9):e441-e448
pubmed: 27562745
BMJ Open. 2018 Sep 1;8(8):e021835
pubmed: 30173159
PLoS Med. 2013;10(9):e1001509
pubmed: 24019763
Nature. 2018 Feb 28;555(7694):41-47
pubmed: 29493591
Lancet. 2007 Feb 24;369(9562):657-66
pubmed: 17321311
Lancet. 2018 Nov 10;392(10159):1789-1858
pubmed: 30496104
PLoS One. 2015 Feb 17;10(2):e0107042
pubmed: 25689585
Lancet Glob Health. 2017 Nov;5(11):e1113-e1122
pubmed: 29025633
HIV AIDS (Auckl). 2014 Oct 08;6:139-46
pubmed: 25336991
J Law Med. 2012 Sep;20(1):93-123
pubmed: 23156651
Lancet HIV. 2018 May;5(5):e241-e249
pubmed: 29650451
PLoS One. 2017 Apr 25;12(4):e0175928
pubmed: 28441458
AIDS. 2012 Mar 13;26(5):609-15
pubmed: 22210632
Clin Chem. 2019 Jan;65(1):15-18
pubmed: 30602469
Lancet. 2008 Dec 13;372(9655):2031-46
pubmed: 19070738
PLoS One. 2015 May 05;10(5):e0125436
pubmed: 25942703
Lancet. 2007 Feb 24;369(9562):643-56
pubmed: 17321310
PLoS One. 2011;6(5):e19814
pubmed: 21603622
Int J Epidemiol. 1990 Sep;19(3):693-7
pubmed: 2262266
Transl Androl Urol. 2017 Apr;6(2):149-157
pubmed: 28540221
Lancet. 2014 Jul 19;384(9939):249-56
pubmed: 25042235
PLoS One. 2017 May 12;12(5):e0177076
pubmed: 28498835
AIDS Behav. 2007 May;11(3):341-55
pubmed: 17053855
PLoS One. 2016 Jul 13;11(7):e0153363
pubmed: 27410384