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Basourakos SP, Nang QG, Ballman KV, Al Awamlh OAH, Punjani N, Ho K, Barone MA, Awori QD, Ouma D, Oketch J, Christensen AE, Hellar A, Makokha M, Isangu A, Salim R, Lija J, Gray RH, Kiboneka S, Anok A, Kigozi G, Nakabuye R, Ddamulira C, Mulooki A, Odiya S, Nazziwa R, Goldstein M, Li PS, Lee RK. ShangRing versus Mogen clamp for early infant male circumcision in eastern sub-Saharan Africa: a multicentre, non-inferiority, adaptive, randomised controlled trial. Lancet Glob Health 2022; 10:e1514-e1522. [DOI: 10.1016/s2214-109x(22)00326-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 06/18/2022] [Accepted: 07/18/2022] [Indexed: 01/01/2023]
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Goga AE, Dinh TH, Essajee S, Chirinda W, Larsen A, Mogashoa M, Jackson D, Cheyip M, Ngandu N, Modi S, Bhardwaj S, Chirwa E, Pillay Y, Mahy M. What will it take for the Global Plan priority countries in Sub-Saharan Africa to eliminate mother-to-child transmission of HIV? BMC Infect Dis 2019; 19:783. [PMID: 31526371 PMCID: PMC6745780 DOI: 10.1186/s12879-019-4393-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The 2016 'Start Free, Stay Free, AIDS Free' global agenda, builds on the 2011-2015 'Global Plan'. It prioritises 22 countries where 90% of the world's HIV-positive pregnant women live and aims to eliminate vertical transmission of HIV (EMTCT) and to keep mothers alive. By 2019, no Global Plan priority country had achieved EMTCT; however, 11 non-priority countries had. This paper synthesises the characteristics of the first four countries validated for EMTCT, and of the 21 Global Plan priority countries located in Sub-Saharan Africa (SSA). We consider what drives vertical transmission of HIV (MTCT) in the 21 SSA Global Plan priority countries. METHODS A literature review, using PubMed, Science direct and the google search engine was conducted to obtain global and national-level information on current HIV-related context and health system characteristics of the first four EMTCT-validated countries and the 21 SSA Global Plan priority countries. Data representing only one clinic, hospital or region were excluded. Additionally, key global experts working on EMTCT were contacted to obtain clarification on published data. We applied three theories (the World Health Organisation's building blocks to strengthen health systems, van Olmen's Health System Dynamics framework and Baral's socio-ecological model for HIV risk) to understand and explain the differences between EMTCT-validated and non-validated countries. Additionally, structural equation modelling (SEM) and linear regression were used to explain associations between infant HIV exposure, access to antiretroviral therapy and two outcomes: (i) percent MTCT and (iii) number of new paediatric HIV infections per 100 000 live births (paediatric HIV case rate). RESULTS EMTCT-validated countries have lower HIV prevalence, less breastfeeding, fewer challenges around leadership, governance within the health sector or country, infrastructure and service delivery compared with Global Plan priority countries. Although by 2016 EMTCT-validated countries and Global Plan priority countries had adopted a public health approach to HIV prevention, recommending lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and lactating women, EMCT-validated countries had also included contact tracing such as assisted partner notification, and had integrated maternal and child health (MCH) and sexual and reproductive health (SRH) services, with services for HIV infection, sexually transmitted infections, and viral hepatitis. Additionally, Global Plan priority countries have limited data on key SRH indicators such as unmet need for family planning, with variable coverage of antenatal care, HIV testing and triple antiretroviral therapy (ART) and very limited contact tracing. Structural equation modelling (SEM) and linear regression analysis demonstrated that ART access protects against percent MTCT (p<0.001); in simple linear regression it is 53% protective against percent MTCT. In contrast, SEM demonstrated that the case rate was driven by the number of HIV exposed infants (HEI) i.e. maternal HIV prevalence (p<0.001). In linear regression models, ART access alone explains only 17% of the case rate while HEI alone explains 81% of the case rate. In multiple regression, HEI and ART access accounts for 83% of the case rate, with HEI making the most contribution (coef. infant HIV exposure=82.8, 95% CI: 64.6, 101.1, p<0.001 vs coef. ART access=-3.0, 95% CI: -6.2, 0.3, p=0.074). CONCLUSION Reducing infant HIV exposure, is critical to reducing the paediatric HIV case rate; increasing ART access is critical to reduce percent MTCT. Additionally, our study of four validated countries underscores the importance of contact tracing, strengthening programme monitoring, leadership and governance, as these are potentially-modifiable factors.
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Affiliation(s)
- Ameena E. Goga
- Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001 South Africa
- HIV Prevention Research Unit, South African Medical Researh Council, Pretoria, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, 0001 South Africa
| | - Thu-Ha Dinh
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Shaffiq Essajee
- Department of HIV/AIDS, World Health Organisation, 27, CH-1211 Geneva, Switzerland
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001 South Africa
| | - Anna Larsen
- Centers for Disease Control and Prevention, Pretoria, 0001 South Africa
| | - Mary Mogashoa
- Centers for Disease Control and Prevention, Pretoria, 0001 South Africa
| | - Debra Jackson
- Health section, United Nations Children’s Fund (UNICEF), New York, 10017 USA
- School of Public Health, University of the Western Cape, Cape Town, 7535 South Africa
| | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, 0001 South Africa
| | - Nobubelo Ngandu
- Health Systems Research Unit, South African Medical Research Council, Pretoria, 0001 South Africa
| | - Surbhi Modi
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329 USA
| | - Sanjana Bhardwaj
- Health section, UNICEF South Africa, Pretoria, 0001 South Africa
| | - Esnat Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, 0001 South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, 2193 South Africa
| | - Yogan Pillay
- Chief Director HIV/AIDS, TB, MCWHN, National Department of Health, Pretoria, 0001 South Africa
| | - Mary Mahy
- Strategic Information and Evaluation Department, UNAIDS, 1211 Geneva, Switzerland
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Ndagijimana A, Mugenzi P, Thomson DR, Hedt-Gauthier B, Condo JU, Ngoga E. PrePex Male Circumcision: Follow-Up and Outcomes during the First Two Years of Implementation at the Rwanda Military Hospital. PLoS One 2015; 10:e0138287. [PMID: 26398343 PMCID: PMC4580619 DOI: 10.1371/journal.pone.0138287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background PrePex Male Circumcision (MC) has been demonstrated as an effective and scalable strategy to prevent HIV infection in low- and middle-income countries. This study describes the follow-up and outcomes of clients who underwent PrePex MC between January 2011 and December 2012 with weekly follow-up at the Rwanda Military Hospital, the first national hospital in Rwanda to adopt PrePex. Methods Data on570 clients age 21 to 54 were extracted from patient records. We compared socio-demographic and clinical characteristics, the operator's qualification, HIV status, pain before and after device removal, urological status, device size and follow-up time between clients who were formally discharged and those who defaulted. We reported bivariate associations between each covariate and discharge status, number of people with adverse events by discharge status, and time to formal discharge or defaulting using life table methods. Data were entered into Epidata and analyzed with Stata v13. Results Among study participants, 96.5% were circumcised by non-physician operators, 85.4%were under 30years, 98.9% were HIV-negative and 97.9% were without any urological problems that could delay the healing time. Most (70.7%) defaulted before formal discharge. Pain before (p<0.001) and after PrePex device removal (p = 0.001) were associated with discharge status, although very few cases were reported, and pain was more commonly missing among defaulters. Twenty-seven adverse events were reported (7 formally discharged, 20 defaulters). Median follow-up time was seven weeks among formally discharged and six weeks among defaulters (p<0.001). Conclusion Given that all socio-demographic and most clinical characteristics were not associated with defaulting, we hypothesize that clients stopped returning once they determined they were healed. We recommend less frequent follow-up protocols to encourage clinical visits until formal discharge. Based on these results and recommendations, we believe PrePex MC is a practical circumcision strategy in Rwanda and in sub-Saharan Africa.
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Affiliation(s)
- Albert Ndagijimana
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
| | | | - Dana R Thomson
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bethany Hedt-Gauthier
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeanine U Condo
- University of Rwanda College of Medicine and Health Sciences School of Public Health, Kigali, Rwanda
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Chemtob D, Op de Coul E, van Sighem A, Mor Z, Cazein F, Semaille C. Impact of Male Circumcision among heterosexual HIV cases: comparisons between three low HIV prevalence countries. Isr J Health Policy Res 2015; 4:36. [PMID: 26244087 PMCID: PMC4524174 DOI: 10.1186/s13584-015-0033-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/11/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies performed in high-HIV prevalence countries showed a strong epidemiological association between male circumcision (MC) and the prevention of HIV transmission. We estimated the potential impact of MC on the general heterosexual population in low-HIV prevalence countries. METHODS Cross-national comparisons, including data on newly diagnosed HIV cases among heterosexuals living in Israel (where almost all males undergo MC), to similar data from the Netherlands and France (where <10 % of males are circumcised) were performed. National data from HIV registers and Bureaus of Statistics for the period of 2004-2010, global rates, rates by sex, age, and year of HIV-diagnosis were compared. MC and potential biases were examined. RESULTS Annual rates of new HIV diagnoses per 100,000 were significantly lower in Israel compared to the Netherlands and France (for men: 0.26-0.70, 1.91-2.28, and 2.69-3.47, respectively; for women: 0.10-0.34, 1.10-2.10 and 2.41-3.08, respectively). Similarly, HIV-rates were much lower in Israel when comparing by age groups. Although Gross National Income per capita in 2010 was lower in Israel compared to the Netherlands and France, access to HIV testing and treatment were not different between countries. Also, the number of sexual-partners and condom-use in the general population showed a high similarity between the countries. CONCLUSIONS The lower rate of HIV among heterosexuals in Israel compared to the Netherlands and France might be explained by MC routinely practiced in Israel, since other parameters of influence on HIV transmission were rather similar between the countries. However, recommendation for systematic MC in low HIV prevalence countries requires further investigations.
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Affiliation(s)
- Daniel Chemtob
- />Department of Tuberculosis and AIDS, Ministry of Health, P.O.B. 1176, Jerusalem, 944727 Israel
| | - Eline Op de Coul
- />Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Zohar Mor
- />Department of Tuberculosis and AIDS, Ministry of Health, P.O.B. 1176, Jerusalem, 944727 Israel
| | - Françoise Cazein
- />HIV/AIDS-STI-Hepatitis B and C Unit, Department of Infectious Diseases, Institut de Veille Sanitaire, Saint Maurice, France
| | - Caroline Semaille
- />HIV/AIDS-STI-Hepatitis B and C Unit, Department of Infectious Diseases, Institut de Veille Sanitaire, Saint Maurice, France
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Hoffman JR, Arendse KD, Larbi C, Johnson N, Vivian LMH. Perceptions and knowledge of voluntary medical male circumcision for HIV prevention in traditionally non-circumcising communities in South Africa. Glob Public Health 2015; 10:692-707. [PMID: 25727250 DOI: 10.1080/17441692.2015.1014825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Voluntary medical male circumcision (VMMC) has been recommended for the prevention of HIV transmission, particularly in sub-Saharan Africa. Uptake of the campaign has been relatively poor, particularly in traditionally non-circumcising regions. This study evaluates the knowledge, attitudes and practices of medical male circumcision (MC) of 104 community members exposed to promotional campaigns for VMMC for five years. Results show that 93% of participants have heard of circumcision and 72% have heard of some health benefit from the practice. However, detailed knowledge of the relationship with HIV infection is lacking: 12.2% mistakenly believed you could not get HIV after being circumcised, while 75.5% believe that a circumcised man is still susceptible and another 12.2% do not know of any relationship between HIV and MC. There are significant barriers to the uptake of the practice, including misperceptions and fear of complications commonly attributed to traditional, non-medical circumcision. However, 88.8% of participants believe circumcision is an acceptable practice, and community-specific promotional campaigns may increase uptake of the service.
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Affiliation(s)
- Jacob Robin Hoffman
- a Department of Public Health , University of Cape Town , Cape Town , South Africa
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