HIV Incidence by Male Circumcision Status From the Population-Based HIV Impact Assessment Surveys-Eight Sub-Saharan African Countries, 2015-2017.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
received:
02
12
2020
accepted:
21
12
2020
pubmed:
26
3
2021
medline:
6
11
2021
entrez:
25
3
2021
Statut:
ppublish
Résumé
Male circumcision (MC) offers men lifelong partial protection from heterosexually acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally representative samples. Data from the population-based HIV impact assessments were used to compare HIV incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. Data were pooled from population-based HIV impact assessments conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2017. Incidence was measured using a recent infection testing algorithm and analyzed by self-reported MC status distinguishing between medical and nonmedical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random-effects logistic regression model using pooled survey weights. Analyses were age stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men [0.04% (95% CI: 0.00% to 0.10%) versus 0.34% (95% CI: 0.10% to 0.57%), respectively; P value = 0.01]; whereas among men 35-59 years, there was no significant incidence difference [1.36% (95% CI: 0.32% to 2.39%) versus 0.55% (95% CI: 0.14% to 0.67%), respectively; P value = 0.14]. Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.
Sections du résumé
BACKGROUND
Male circumcision (MC) offers men lifelong partial protection from heterosexually acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally representative samples. Data from the population-based HIV impact assessments were used to compare HIV incidence by MC status in countries implementing voluntary medical MC (VMMC) programs.
METHODS
Data were pooled from population-based HIV impact assessments conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2017. Incidence was measured using a recent infection testing algorithm and analyzed by self-reported MC status distinguishing between medical and nonmedical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random-effects logistic regression model using pooled survey weights. Analyses were age stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men.
RESULTS
Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men [0.04% (95% CI: 0.00% to 0.10%) versus 0.34% (95% CI: 0.10% to 0.57%), respectively; P value = 0.01]; whereas among men 35-59 years, there was no significant incidence difference [1.36% (95% CI: 0.32% to 2.39%) versus 0.55% (95% CI: 0.14% to 0.67%), respectively; P value = 0.14].
DISCUSSION
Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.
Identifiants
pubmed: 33765683
doi: 10.1097/QAI.0000000000002658
pii: 00126334-202108011-00011
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
S89-S96Subventions
Organisme : PEPFAR
Pays : United States
Organisme : CGH CDC HHS
ID : U2G GH001226
Pays : United States
Organisme : CGH CDC HHS
ID : U2G GH001271
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
As an inventor of LAg-Avidity EIA (HIV-1 incidence assay), B.P. receives a portion of royalties as per policies of the US government. The remaining authors have no conflicts of interest to disclose.
Références
UNAIDS. AIDSinfo | UNAIDS. People living with HIV (all ages). Available at: http://aidsinfo.unaids.org/ .
Siegfried N, Muller M, Deeks JJ, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev. 2009:CD003362.
Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2:e298.
Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369:643–656.
Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369:657–666.
PEPFAR.. PEPFAR Latest Global Results; 2018. Available at: https://www.state.gov/wp-content/uploads/2020/12/PEPFAR-Latest-Results-Fact-Sheet-2020.pdf . Accessed November 3, 2021.
UNAIDS, W. Voluntary Medical Male Circumcision Progress Brief; 2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/330010/WHO-CDS-HIV-19.50-eng.pdf?sequence=1&isAllowed=y . Accessed November 3, 2021.
Gray R, Kigozi G, Kong X, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a posttrial follow-up study. AIDS. 2012;26:609–615.
Mehta SD, Moses S, Agot K, et al. The long-term efficacy of medical male circumcision against HIV acquisition. AIDS. 2013;27:2899–2907.
Auvert B, Taljaard D, Rech D, et al. Association of the ANRS-12126 male circumcision project with HIV levels among men in a South African township: evaluation of effectiveness using cross-sectional surveys. PLoS Med. 2013;10:e1001509.
Kong X, Kigozi G, Ssekasanvu J, et al. Association of medical male circumcision and antiretroviral therapy scale-up with community HIV incidence in rakai, Uganda. JAMA. 2016;316:182–190.
Grabowski MK, Serwadda DM, Gray RH, et al. HIV prevention efforts and incidence of HIV in Uganda. N Engl J Med. 2017;377:2154–2166.
Borgdorff MW, Kwaro D, Obor D, et al. HIV incidence in western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis. Lancet HIV. 2018;5:e241–e249.
Lissouba P, Taljaard D, Rech D, et al. Adult male circumcision as an intervention against HIV: an operational study of uptake in a South African community (ANRS 12126). BMC Infect Dis. 2011;11:253.
Kagaayi J, Chang LW, Ssempijja V, et al. Impact of combination HIV interventions on HIV incidence in hyperendemic fishing communities in Uganda: a prospective cohort study. Lancet HIV. 2019;6:e680–e687.
Bershteyn AAA, Klein DJ, Jewell B, et al. Scale-up of ART and VMMC explain a two-fold decline in HIV incidence in Western Kenya. Conference on Retroviruses and Opportunistic Infections. Washington, Seattle; June 3, 2019.
Justman JE, Mugurungi O, El-Sadr WM. HIV population surveys - bringing precision to the global response. N Engl J Med. 2018;378:1859–1861.
Brown K, Williams DB, Kinchen S, et al. Status of HIV epidemic control among adolescent girls and young women aged 15-24 Years—seven african countries, 2015-2017. MMWR Morb Mortal Wkly Rep. 2018;67:29–32.
Duong YT, Dobbs T, Mavengere Y, et al. Field validation of limiting-antigen avidity enzyme immunoassay to estimate HIV-1 incidence in cross-sectional survey in Swaziland. AIDS Res Hum Retroviruses. 2019;35:896–905.
Kim AA, Rehle T. Short communication: assessing estimates of HIV incidence with a recent infection testing algorithm that includes viral load testing and exposure to antiretroviral therapy. AIDS Res Hum Retroviruses. 2018;34:863–866.
Thomas AG, Tran BR, Cranston M, et al. Voluntary medical male circumcision: a cross-sectional study comparing circumcision self-report and physical examination findings in Lesotho. PLoS One. 2011;6:e27561.
World Health Organization. Traditional Male Circumcision Among Young People: A Public Health Perspective in the Context of HIV Prevention; 2009.. Available at: https://apps.who.int/iris/handle/10665/44247 . Accessed November 3, 2021.
Maughan-Brown B, Venkataramani AS, Nattrass N, et al. A cut above the rest: traditional male circumcision and HIV risk among Xhosa men in Cape Town, South Africa. J Acquir Immune Defic Syndr. 2011;58:499–505.
Peltzer K, Kanta X, Banyini M. Evaluation of a safer male circumcision training programme for Ndebele traditional surgeons and nurses in Gauteng, South Africa: using direct observation of circumcision procedures. Afr J Tradit Complement Altern Med. 2009;7:153–159.
Kigozi G, Wawer M, Ssettuba A, et al. Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters). AIDS. 2009;23:2209–2213.
Kripke K, Njeuhmeli E, Samuelson J, et al. Assessing progress, impact, and next steps in rolling out voluntary medical male circumcision for HIV prevention in 14 priority countries in eastern and southern Africa through 2014. PLoS One. 2016;11:e0158767.
Tanser F, Vandormael A, Cuadros D, et al. Effect of population viral load on prospective HIV incidence in a hyperendemic rural African community. Sci Transl Med. 2017;9:eaam8012.
Farahani M, Radin E, Saito S, et al. Population Viral Load, Viremia and Recent HIV-1 Infections: Findings from Population-based HIV Impact Assessments (PHIAs) in Zimbabwe, Malawi, and Zambia. J Acquir Immune Defic Syndr. 2021. Epub ahead of print.
Mermin J, Musinguzi J, Opio A, et al. Risk factors for recent HIV infection in Uganda. JAMA. 2008;300:540–549.
Kahle EM, Hughes JP, Lingappa JR, et al. An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-serodiscordant couples for targeted HIV-1 prevention. J Acquir Immune Defic Syndr. 2013;62:339–347.
Kagaayi J, Gray RH, Whalen C, et al. Indices to measure risk of HIV acquisition in Rakai, Uganda. PLoS One. 2014;9:e92015.
Balkus JE, Brown E, Palanee T, et al. An empiric HIV risk scoring tool to predict HIV-1 acquisition in african women. J Acquir Immune Defic Syndr. 2016;72:333–343.
Santelli JS, Edelstein ZR, Mathur S, et al. Behavioral, biological, and demographic risk and protective factors for new HIV infections among youth in Rakai, Uganda. J Acquir Immune Defic Syndr. 2013;63:393–400.
South African Centre for Epidemiological Modelling and Analysis (SACEMA), Inctools R Package. Available at: https://github.com/SACEMA/inctools .
Kassanjee R, McWalter TA, Bärnighausen T, et al. A new general biomarker-based incidence estimator. Epidemiology. 2012;23:721–728.
World Health Organization, UNAIDS. A Framework for Voluntary Medical Male Circumcision. Effective HIV Prevention and a Gateway to Improved Adolescent Boys' & Men's Health in Eastern and Southern Africa by 2021. World Health Organization; 2016. Available at: https://apps.who.int/iris/handle/10665/246234 . Accessed November 3, 2021.
Lipsitch M, Goldstein E, Ray GT, Fireman B. Depletion-of-susceptibles bias in influenza vaccine waning studies: how to ensure robust results. Epidemiol Infect. 2019 Nov 27;147:e306..
Agot KE, Ndinya-Achola JO, Kreiss JK, et al. Risk of HIV-1 in rural Kenya: a comparison of circumcised and uncircumcised men. Epidemiology. 2004;15:157–163.
Westercamp M, Bailey RC, Bukusi EA, et al. Male circumcision in the general population of Kisumu, Kenya: beliefs about protection, risk behaviors, HIV, and STIs. PLoS One. 2010;5:e15552.
Westercamp M, Agot KE, Ndinya-Achola J, et al. Circumcision preference among women and uncircumcised men prior to scale-up of male circumcision for HIV prevention in Kisumu, Kenya. AIDS Care. 2012;24:157–166.
Odoyo-June E, Agot K, Mboya E, et al. Agreement between self-reported and physically verified male circumcision status in Nyanza region, Kenya: evidence from the TASCO study. PLoS One. 2018;13:e0192823.
Hewett PC, Haberland N, Apicella L, et al. The (mis)reporting of male circumcision status among men and women in Zambia and Swaziland: a randomized evaluation of interview methods. PLoS One. 2012;7:e36251.
Weiss HA, Plummer ML, Changalucha J, et al. Circumcision among adolescent boys in rural northwestern Tanzania. Trop Med Int Health. 2008;13:1054–1061.
Lagarde E, Dirk T, Puren A, et al. Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa. AIDS. 2003;17:89–95.