The Experts below are selected from a list of 28140 Experts worldwide ranked by ideXlab platform
Ronald H Gray - One of the best experts on this subject based on the ideXlab platform.
-
the effectiveness of male Circumcision for hiv prevention and effects on risk behaviors in a posttrial follow up study
AIDS, 2012Co-Authors: Ronald H Gray, Godfrey Kigozi, David Serwadda, Frederick Makumbi, Fred Nalugoda, Xiangrong Kong, Victor Ssempiija, Stephen Wattya, Nelson K Sewenkambo, Maria J WawerAbstract:Background The efficacy of male Circumcision for HIV prevention over 2 years has been demonstrated in three randomized trials, but the longer-term effectiveness of male Circumcision is unknown. Methods We conducted a randomized trial of male Circumcision in 4996 HIV-negative men aged 15-49 in Rakai, Uganda. Following trial closure, we offered male Circumcision to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years was assessed in an as-treated analysis, and the effectiveness of male Circumcision was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first posttrial visits were assessed by subsequent Circumcision acceptance to detect behavioral risk compensation. Results By 15 December 2010, 78.4% of uncircumcised trial participants accepted male Circumcision following trial closure. During posttrial surveillance, overall HIV incidence was 0.50/100 person-years in circumcised men and 1.93/100 person-years in uncircumcised men {adjusted effectiveness 73% [95% confidence interval (CI) 55-84%]}. In control arm participants, posttrial HIV incidence was 0.54/100 person-years in circumcised and 1.71/100 person-years in uncircumcised men [adjusted effectiveness 67% (95% CI 38-83%)]. There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting male Circumcision and those remaining uncircumcised. Conclusion High effectiveness of male Circumcision for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with posttrial male Circumcision acceptance.
-
The Medical Benefits of Male Circumcision
JAMA, 2011Co-Authors: Aaron A. R. Tobian, Ronald H GrayAbstract:With 2 new states recently joining 16 others in eliminating Medicaid insurance for male Circumcision, possible ballot initiatives to ban male Circumcision, and the long-awaited American Academy of Pediatrics male Circumcision policy statement, there is a need to evaluate the medical risks and benefits of male Circumcision, particularly in light of recent medical evidence. Three randomized trials in Africa demonstrated that adult male Circumcision decreases human immunodeficiency virus (HIV) acquisition in men by 51% to 60%,1 and the long-term follow-up of these study participants has shown that the protective efficacy of male Circumcision increases with time from surgery. These findings are consistent with a large number of observational studies in Africa and in the United States that found male Circumcision reduces the risk of HIV infection in men.1 Thus, there is substantial evidence that removal of the foreskin reduces the risk of male heterosexual HIV acquisition. However, the effect of male Circumcision on reducing HIV acquisition among men who have sex with men is unclear. There may be protection against insertional but not against receptive anal intercourse, so men practicing both forms of sexual intercourse may have limited protection associated with male Circumcision. In addition to HIV, male Circumcision has been shown to reduce the risk of other heterosexually acquired sexually transmitted infections (STIs). Two trials demonstrated that male Circumcision reduces the risk of acquiring genital herpes by 28% to 34%, and the risk of developing genital ulceration by 47%.1 Additionally, the trials found that male Circumcision reduces the risk of oncogenic high-risk human papillomavirus (HR-HPV) by 32% to 35%.1 While some consider male Circumcision to be primarily a male issue, one trial also reported derivative benefits for female partners of circumcised men; the risk of HR-HPV for female partners was reduced by 28%, the risk of bacterial vaginosis was reduced by 40%, and the risk of trichomoniasis was reduced by 48%.1,2 It should be noted that no large-scale randomized controlled trial has assessed the benefit of neonatal male Circumcision throughout several decades, which is when many of the potential health benefits would be realized. Such a trial is probably not feasible. However, observational data of men predominantly circumcised during childhood support the findings of the 3 randomized trials conducted in Africa1 and the long-term medical benefits of male Circumcision. One concern is that the trials of male Circumcision conducted in Africa may not be applicable to the United States. Despite 3 decades of safe-sex education in the United States, STIs continue to cause substantial morbidity and mortality. It is estimated that more than 1 million people are living with HIV/AIDS, and more than 50 000 new infections occur annually. Additional estimates suggest that there are 3 million to 5 million annual cases of trichomoniasis in the United States, and the prevalence of bacterial vaginosis among women of reproductive age is approximately 30%. One of the most common STIs is HPV, which causes genital warts, and penile and cervical cancer. Observational studies in the United States show that male Circumcision is associated with reduced risk of men acquiring heterosexual HIV and HR-HPV infection.1,3 Thus, STIs are a persistent problem in the United States, and male Circumcision may provide individual and societal benefits. The incidence of viral STIs in the United States is disproportionately higher among disadvantaged minority populations such as blacks and Hispanics, who have the lowest rates of male Circumcision. For example, in Washington, DC, 7.1% of black males are living with HIV, and heterosexual exposure is the leading mode of transmission among these individuals.4 Medicaid, which disproportionately provides health insurance for black children, is decreasing coverage for male Circumcision, making the procedure less accessible, especially for those at the highest risk for these infections.5 In contrast, Medicaid covers immunization against hepatitis B virus during the neonatal period even though it is difficult to predict who will be at high risk of STIs. Using mathematical models and cost-effectiveness analyses, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization adopted a policy advocating male Circumcision in countries and regions with heterosexual HIV epidemics. In a cost-effectiveness analysis by the Centers for Disease Control and Prevention, neonatal male Circumcision in the United States was projected to increase quality-adjusted life-years and estimated to be cost-saving due to reduced HIV infections and subsequent treatment costs.6 If protection from genital herpes, bacterial vaginosis, trichomoniasis, and penile and cervical cancer were considered in the analyses, the economic benefits most likely would be enhanced. Opponents of male Circumcision argue that the procedure constitutes genital mutilation performed with parental consent but not the infant’s assent and recommend that male Circumcision be delayed until 18 years of age when the man can provide individual informed consent to the procedure. However, parents provide consent for preventive procedures such as immunization including hepatitis B vaccination, acting in the best interests of their children. UNAIDS recommends providing information on risks and benefits of early infant neonatal male Circumcision so parents and guardians can make informed decisions on behalf of their children with the best interests of the child as the primary consideration.7 Additionally, a ban on neonatal male Circumcision denies religious freedoms to Jewish and Muslim parents, which would be potentially unconstitutional. Neonatal male Circumcision provides other potential benefits during childhood such as prevention of infant urinary tract infections, meatitis, balanitis, and phimosis,8 as well as protection from viral STIs. Approximately 50% of high school students report having sex prior to 18 years of age, so delaying male Circumcision to age 18 years or older would deny children and adolescents these potential benefits. Neonatal male Circumcision is a simple procedure and the complication rate is only between 0.2% and 0.6%8; the vast majority of complications are minor and easily treated. The complication rate of neonatal male Circumcision is substantially lower than the complication rates of adult male Circumcision (1.5%-3.8% during the trials), so delaying the procedure would only add to surgical risk. Some who oppose male Circumcision cite anecdotal reports that male Circumcision can cause sexual dysfunction. The male Circumcision trials evaluated sexual satisfaction in adult men and their female partners before and after the procedure and compared men randomized to male Circumcision with uncircumcised controls. There were no significant differences in male sexual satisfaction or dysfunction among trial participants, and in one trial, circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm.9 In addition, 97% of female partners reported either no change or improved sexual satisfaction after their male partner was circumcised.10 The evidence for the long-term public health benefits of male Circumcision has increased substantially during the past 5 years. If a vaccine were available that reduced HIV risk by 60%, genital herpes risk by 30%, and HR-HPV risk by 35%, the medical community would rally behind the immunization and it would be promoted as a game-changing public health intervention. Based on the medical evidence, banning infant male Circumcision would deprive parents of the right to act on behalf of their children’s health. Parents should be provided with information derived from evidence-based medicine about the risks and benefits of male Circumcision so that they can make an informed choice for their children. It would be ethically questionable to deprive them of this choice. Medicaid and other insurance carriers should cover male Circumcision costs if parents opt for the procedure, and the medical community, including the American Academy of Pediatrics and the Centers for Disease Control and Prevention, should recognize the health benefits of male Circumcision in order to properly inform parents and physicians.
-
will Circumcision provide even more protection from hiv to women and men new estimates of the population impact of Circumcision interventions
Sexually Transmitted Infections, 2011Co-Authors: Timothy B Hallett, Ronald H Gray, Helen A Weiss, Ramzi Alsallaq, Jared M Baeten, Connie Celum, Laith J AburaddadAbstract:Background Mathematical modelling has indicated that expansion of male Circumcision services in high HIV prevalence settings can substantially reduce populationlevel HIV transmission. However, these projections need revision to incorporate new data on the effect of male Circumcision on the risk of acquiring and transmitting HIV. Methods Recent data on the effect of male Circumcision during wound healing and the risk of HIV transmission to women were synthesised based on four trials of Circumcision among adults and new observational data of HIV transmission rates in stable partnerships from men circumcised at younger ages. New estimates were generated for the impact of Circumcision interventions in two mathematical models, representing the HIV epidemics in Zimbabwe and Kisumu, Kenya. The models did not capture the interaction between Circumcision, HIV and other sexually transmitted infections. Results An increase in the risk of HIV acquisition and transmission during wound healing is unlikely to have a major impact of Circumcision interventions. However, it was estimated that Circumcision confers a 46% reduction in the rate of male-to-female HIV transmission. If this reduction begins 2 years after the procedure, the impact of Circumcision is substantially enhanced and accelerated compared with previous projections with no such effectdincreasing by 40% the infections averted by the intervention overall and doubling the number of infections averted among women. Conclusions Communities, and especially women, may benefit much more from Circumcision interventions than had previously been predicted, and these results provide an even greater imperative to increase scale-up of safe male Circumcision services.
-
Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections: The Case for Neonatal Circumcision
JAMA Pediatrics, 2010Co-Authors: Aaron A. R. Tobian, Ronald H Gray, Thomas C. QuinnAbstract:The American Academy of Pediatrics (AAP) male Circumcision policy states that while there are potential medical benefits of newborn male Circumcision, the data are insufficient to recommend routine neonatal Circumcision. Since 2005, however, 3 randomized trials have evaluated male Circumcision for prevention of sexually transmitted infections. The trials found that Circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. Genital ulcer disease was also reduced among males and their female partners. These findings are also supported by observational studies conducted in the United States. The AAP policy has a major impact on neonatal Circumcision in the United States. This review evaluates the recent data that support revision of the AAP policy to fully reflect the evidence of long-term health benefits of male Circumcision.
-
the impact of male Circumcision on hiv incidence and cost per infection prevented a stochastic simulation model from rakai uganda
AIDS, 2007Co-Authors: Ronald H Gray, Godfrey Kigozi, David Serwadda, Stephen Watya, Fred Nalugoda, Xianbin Li, Steven James Reynolds, Maria J WawerAbstract:The objectives were to estimate the impact of male Circumcision on HIV incidence the number of procedures per HIV infection averted and costs per infection averted. A stochastic simulation model with empirically derived parameters from a cohort in Rakai Uganda was used to estimate HIV incidence assuming that male Circumcision reduced the risks of HIV acquisition with rate ratios (RR) ranging from 0.3 to 0.6 in men their female partners and in both sexes combined with Circumcision coverage 0-100%. The reproductive number (R0) was also estimated. The number of HIV infections averted per Circumcision was estimated from the incident cases in the absence of surgery minus the projected number of incident cases over 10 years following Circumcision. The cost per procedure ($69.00) was used to estimate the cost per HIV infection averted. Baseline HIV incidence was 1.2/100 person-years. Male Circumcision could markedly reduce HIV incidence in this population particularly if there was preventative efficacy in both sexes. Under many scenarios with RR = 0.5 Circumcision could reduce R0 to < 1.0 and potentially abort the epidemic. The number of surgeries per infection averted over 10 years was 19-58 and the costs per infection averted was $1269-3911 depending on the efficacy of Circumcision for either or both sexes assuming 75% service coverage. However behavioral disinhibition could offset any benefits of Circumcision. Male Circumcision could have substantial impact on the HIV epidemic and provide a cost-effective prevention strategy if benefits are not countered by behavioral disinhibition. (authors)
Laith J Aburaddad - One of the best experts on this subject based on the ideXlab platform.
-
will Circumcision provide even more protection from hiv to women and men new estimates of the population impact of Circumcision interventions
Sexually Transmitted Infections, 2011Co-Authors: Timothy B Hallett, Ronald H Gray, Helen A Weiss, Ramzi Alsallaq, Jared M Baeten, Connie Celum, Laith J AburaddadAbstract:Background Mathematical modelling has indicated that expansion of male Circumcision services in high HIV prevalence settings can substantially reduce populationlevel HIV transmission. However, these projections need revision to incorporate new data on the effect of male Circumcision on the risk of acquiring and transmitting HIV. Methods Recent data on the effect of male Circumcision during wound healing and the risk of HIV transmission to women were synthesised based on four trials of Circumcision among adults and new observational data of HIV transmission rates in stable partnerships from men circumcised at younger ages. New estimates were generated for the impact of Circumcision interventions in two mathematical models, representing the HIV epidemics in Zimbabwe and Kisumu, Kenya. The models did not capture the interaction between Circumcision, HIV and other sexually transmitted infections. Results An increase in the risk of HIV acquisition and transmission during wound healing is unlikely to have a major impact of Circumcision interventions. However, it was estimated that Circumcision confers a 46% reduction in the rate of male-to-female HIV transmission. If this reduction begins 2 years after the procedure, the impact of Circumcision is substantially enhanced and accelerated compared with previous projections with no such effectdincreasing by 40% the infections averted by the intervention overall and doubling the number of infections averted among women. Conclusions Communities, and especially women, may benefit much more from Circumcision interventions than had previously been predicted, and these results provide an even greater imperative to increase scale-up of safe male Circumcision services.
Helen A Weiss - One of the best experts on this subject based on the ideXlab platform.
-
Application of an HIV Prevention Cascade to Identify Gaps in Increasing Coverage of Voluntary Medical Male Circumcision Services in 42 Rural Zambian Communities
AIDS and Behavior, 2019Co-Authors: Bernadette Hensen, Helen A Weiss, Elizabeth Fearon, Ab Schaap, James J. Lewis, Margaret Tembo, Namwinga Chintu, Helen Ayles, James R. HargreavesAbstract:Increased coverage of voluntary medical male Circumcision (VMMC) is needed in countries with high HIV prevalence. We applied an HIV-prevention cascade to identify gaps in male Circumcision coverage in Zambia. We used survey data collected in 2013 and 2014/15 to describe Circumcision coverage at each time-point, and prevalence of variables related to demand for and supply of VMMC. We explored whether Circumcision coverage in 2014/15 was associated with demand and supply among uncircumcised men in 2013. Results show that Circumcision coverage was 11.5% in 2013 and 18.0% in 2014/15. Levels of having heard of Circumcision and agreeing with prevention benefits was similar at both time-points (79.8% vs 83.2%, and 49.7% vs 50.7%, respectively). In 2013, 39.3% of men perceived services to be available compared to 54.7% in 2014/15. Levels of having heard of Circumcision in 2013 was correlated with and higher perceived service availability associated with coverage in 2014/15. VMMC coverage was low in these study sites. Knowledge of prevention tools and of service availability are necessary to increase coverage but alone are insufficient.
-
will Circumcision provide even more protection from hiv to women and men new estimates of the population impact of Circumcision interventions
Sexually Transmitted Infections, 2011Co-Authors: Timothy B Hallett, Ronald H Gray, Helen A Weiss, Ramzi Alsallaq, Jared M Baeten, Connie Celum, Laith J AburaddadAbstract:Background Mathematical modelling has indicated that expansion of male Circumcision services in high HIV prevalence settings can substantially reduce populationlevel HIV transmission. However, these projections need revision to incorporate new data on the effect of male Circumcision on the risk of acquiring and transmitting HIV. Methods Recent data on the effect of male Circumcision during wound healing and the risk of HIV transmission to women were synthesised based on four trials of Circumcision among adults and new observational data of HIV transmission rates in stable partnerships from men circumcised at younger ages. New estimates were generated for the impact of Circumcision interventions in two mathematical models, representing the HIV epidemics in Zimbabwe and Kisumu, Kenya. The models did not capture the interaction between Circumcision, HIV and other sexually transmitted infections. Results An increase in the risk of HIV acquisition and transmission during wound healing is unlikely to have a major impact of Circumcision interventions. However, it was estimated that Circumcision confers a 46% reduction in the rate of male-to-female HIV transmission. If this reduction begins 2 years after the procedure, the impact of Circumcision is substantially enhanced and accelerated compared with previous projections with no such effectdincreasing by 40% the infections averted by the intervention overall and doubling the number of infections averted among women. Conclusions Communities, and especially women, may benefit much more from Circumcision interventions than had previously been predicted, and these results provide an even greater imperative to increase scale-up of safe male Circumcision services.
-
Complications of Circumcision in male neonates, infants and children: a systematic review
BMC Urology, 2010Co-Authors: Helen A Weiss, Natasha Larke, Daniel Halperin, Inon SchenkerAbstract:Background Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. The aim of this paper is to summarize the literature on frequency of adverse events following pediatric Circumcision, with a focus on developing countries. Methods PubMed and other databasess were searched with keywords and MeSH terms including infant/newborn/pediatric/child, Circumcision, complications and adverse events. Searches included all available years and were conducted on November 6^th 2007 and updated on February 14th 2009. Additional searches of the Arabic literature included searches of relevant databases and University libraries for research theses on male Circumcision. Studies were included if they contained data to estimate frequency of adverse events following neonatal, infant and child Circumcision. There was no language restriction. A total of 1349 published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included. Results Sixteen prospective studies evaluated complications following neonatal and infant Circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child Circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional Circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical Circumcision or traditional Circumcision among neonates. Conclusions Studies report few severe complications following Circumcision. However, mild or moderate complications are seen, especially when Circumcision is undertaken at older ages, by inexperienced providers or in non-sterile conditions. Pediatric Circumcision will continue to be practiced for cultural, medical and as a long-term HIV/STI prevention strategy. Risk-reduction strategies including improved training of providers, and provision of appropriate sterile equipment, are urgently needed.
-
male Circumcision for hiv prevention in sub saharan africa who what and when
AIDS, 2008Co-Authors: Richard G White, Helen A Weiss, Judith R Glynn, Kate K Orroth, Esther E Freeman, Roel Bakker, Lilani Kumaranayake, Dik J F Habbema, Anne Buve, Richard J HayesAbstract:Male Circumcision (Circumcision) reduces HIV incidence in men by 50-60%. The United Nations Joint Programme on HIV/AIDS (UNAIDS) recommends the provision of safe Circumcision services in countries with high HIV and low Circumcision prevalence prioritizing 12-30 years old HIV-uninfected men. We explore how the population-level impact of Circumcision varies by target age group coverage time-to-scale-up level of risk compensation and Circumcision of HIV-infected men. An individual-based model was fitted to the characteristics of a typical high-HIV-prevalence population in sub-Saharan Africa and three scenarios of individual-level impact corresponding to the central and the 95% confidence level estimates from the Kenyan Circumcision trial. The simulated intervention increased the prevalence of Circumcision from 25 to 75% over 5 years in targeted age groups. The impact and cost-effectiveness of the intervention were calculated over 2-50 years. Future costs and effects were discounted and compared with the present value of lifetime HIV treatment costs (US$ 4043). Initially targeting men older than the United Nations Joint Programme on HIV/ AIDS recommended age group may be the most cost-effective strategy but targeting any adult age group will be cost-saving. Substantial risk compensation could negate impact particularly if already circumcised men compensate. If Circumcision prevalence in HIV-uninfected men increases less because HIV-infected men are also circumcised this will reduce impact in men but would have little effect on population-level impact in women. Circumcision is a cost-saving intervention in a wide range of scenarios of HIV and initial Circumcision prevalence but the United Nations Joint Programme on HIV/AIDS/WHO recommended target age group should be widened to include older HIV-uninfected men and counselling should be targeted at both newly and already circumcised men to minimize risk compensation. To maximize infections-averted Circumcision must be scaled up rapidly while maintaining quality. (authors)
-
the acceptability of male Circumcision as an hiv intervention among a rural zulu population kwazulu natal south africa
Aids Care-psychological and Socio-medical Aspects of Aids\ hiv, 2005Co-Authors: Beth Scott, Helen A Weiss, J I ViljoenAbstract:Epidemiological and biological studies provide compelling evidence for the protective effect of male Circumcision against the acquisition of HIV. Three randomized controlled trials are currently underway to assess the impact of male Circumcision as an HIV intervention in traditionally non-circumcising areas with high levels of heterosexually-transmitted infection. This study explores the acceptability of male Circumcision among the rural Zulu around Hlabisa and Mtubatuba, KwaZulu-Natal, South Africa. A cross-sectional convenience sample of 100 men and 44 women was surveyed, and two male focus groups held, to ascertain Circumcision preferences within the population. Four in-depth interviews with service providers assessed the feasibility of promoting male Circumcision. Fifty-one per cent of uncircumcised men and 68% of women favoured male Circumcision of themselves or their partners; while 50% of men and 73% of women would circumcise their sons. For men, the main predictors of Circumcision preference pertained to beliefs surrounding sexual pain and pleasure; for women, knowledge about the relationship between male Circumcision status and STI acquisition was the key indicator for Circumcision preference. Among both sexes the main barrier to Circumcision was fear of pain and death. The greatest logistical barrier was that Circumcision can presently only be carried out by trained hospital doctors.
Valerian Kiggundu - One of the best experts on this subject based on the ideXlab platform.
-
Medically, Traditionally, and Dually Circumcised Men in Lesotho: Population-Based Measurements of HIV/STI Infections, Sexual Risk Behaviors, and Service Use Patterns
AIDS and Behavior, 2020Co-Authors: Maria A. Carrasco, Joseph G. Rosen, Limpho Maile, Robert Manda, Anouk Amzel, Valerian KiggunduAbstract:Voluntary medical male Circumcision (VMMC) is an HIV prevention priority in Lesotho, but uptake remains suboptimal. We analyzed the 2014 Lesotho Demographic and Health Survey to assess population-level social, behavioral, and serological correlates of Circumcision status, specifically traditional and/or medical Circumcision. Among 2931 men, approximately half were traditionally circumcised, and fewer than 25% were medically circumcised. Only 4% were dually (traditionally and medically) circumcised. In multivariate analysis, only medical Circumcision emerged as significantly (p
-
progress in voluntary medical male Circumcision for hiv prevention supported by the us president s emergency plan for aids relief through 2017 longitudinal and recent cross sectional programme data
BMJ Open, 2018Co-Authors: Stephanie M Davis, Jonas Z Hines, Melissa A Habel, Jonathan M Grund, Renee Ridzon, Brittney N Baack, Jonathan Davitte, Anne Thomas, Valerian Kiggundu, Naomi BockAbstract:Objective This article provides an overview and interpretation of the performance of the US President’s Emergency Plan for AIDS Relief’s (PEPFAR’s) male Circumcision programme which has supported the majority of voluntary medical male Circumcisions (VMMCs) performed for HIV prevention, from its 2007 inception to 2017, and client characteristics in 2017. Design Longitudinal collection of routine programme data and disaggregations. Setting 14 countries in sub-Saharan Africa with low baseline male Circumcision coverage, high HIV prevalence and PEPFAR-supported VMMC programmes. Participants Clients of PEPFAR-supported VMMC programmes directed at males aged 10 years and above. Main outcome measures Numbers of Circumcisions performed and disaggregations by age band, result of HIV test offer, procedure technique and follow-up visit attendance. Results PEPFAR supported a total of 15 269 720 Circumcisions in 14 countries in Southern and Eastern Africa. In 2017, 45% of clients were under 15 years of age, 8% had unknown HIV status, 1% of those tested were HIV+ and 84% returned for a follow-up visit within 14 days of Circumcision. Conclusions Over 15 million VMMCs have been supported by PEPFAR since 2007. VMMC continues to attract primarily young clients. The non-trivial proportion of clients not testing for HIV is expected, and may be reassuring that testing is not being presented as mandatory for access to Circumcision, or in some cases reflect test kit stockouts or recent testing elsewhere. While VMMC is extremely safe, achieving the highest possible follow-up rates for early diagnosis and intervention on complications is crucial, and programmes continue to work to raise follow-up rates. The VMMC programme has achieved rapid scale-up but continues to face challenges, and new approaches may be needed to achieve the new Joint United Nations Programme on HIV/AIDS goal of 27 million additional Circumcisions through 2020.
Maria J Wawer - One of the best experts on this subject based on the ideXlab platform.
-
the effectiveness of male Circumcision for hiv prevention and effects on risk behaviors in a posttrial follow up study
AIDS, 2012Co-Authors: Ronald H Gray, Godfrey Kigozi, David Serwadda, Frederick Makumbi, Fred Nalugoda, Xiangrong Kong, Victor Ssempiija, Stephen Wattya, Nelson K Sewenkambo, Maria J WawerAbstract:Background The efficacy of male Circumcision for HIV prevention over 2 years has been demonstrated in three randomized trials, but the longer-term effectiveness of male Circumcision is unknown. Methods We conducted a randomized trial of male Circumcision in 4996 HIV-negative men aged 15-49 in Rakai, Uganda. Following trial closure, we offered male Circumcision to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years was assessed in an as-treated analysis, and the effectiveness of male Circumcision was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first posttrial visits were assessed by subsequent Circumcision acceptance to detect behavioral risk compensation. Results By 15 December 2010, 78.4% of uncircumcised trial participants accepted male Circumcision following trial closure. During posttrial surveillance, overall HIV incidence was 0.50/100 person-years in circumcised men and 1.93/100 person-years in uncircumcised men {adjusted effectiveness 73% [95% confidence interval (CI) 55-84%]}. In control arm participants, posttrial HIV incidence was 0.54/100 person-years in circumcised and 1.71/100 person-years in uncircumcised men [adjusted effectiveness 67% (95% CI 38-83%)]. There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting male Circumcision and those remaining uncircumcised. Conclusion High effectiveness of male Circumcision for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with posttrial male Circumcision acceptance.
-
the impact of male Circumcision on hiv incidence and cost per infection prevented a stochastic simulation model from rakai uganda
AIDS, 2007Co-Authors: Ronald H Gray, Godfrey Kigozi, David Serwadda, Stephen Watya, Fred Nalugoda, Xianbin Li, Steven James Reynolds, Maria J WawerAbstract:The objectives were to estimate the impact of male Circumcision on HIV incidence the number of procedures per HIV infection averted and costs per infection averted. A stochastic simulation model with empirically derived parameters from a cohort in Rakai Uganda was used to estimate HIV incidence assuming that male Circumcision reduced the risks of HIV acquisition with rate ratios (RR) ranging from 0.3 to 0.6 in men their female partners and in both sexes combined with Circumcision coverage 0-100%. The reproductive number (R0) was also estimated. The number of HIV infections averted per Circumcision was estimated from the incident cases in the absence of surgery minus the projected number of incident cases over 10 years following Circumcision. The cost per procedure ($69.00) was used to estimate the cost per HIV infection averted. Baseline HIV incidence was 1.2/100 person-years. Male Circumcision could markedly reduce HIV incidence in this population particularly if there was preventative efficacy in both sexes. Under many scenarios with RR = 0.5 Circumcision could reduce R0 to < 1.0 and potentially abort the epidemic. The number of surgeries per infection averted over 10 years was 19-58 and the costs per infection averted was $1269-3911 depending on the efficacy of Circumcision for either or both sexes assuming 75% service coverage. However behavioral disinhibition could offset any benefits of Circumcision. Male Circumcision could have substantial impact on the HIV epidemic and provide a cost-effective prevention strategy if benefits are not countered by behavioral disinhibition. (authors)