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Nelson SG, Liu CM. Penile microbiome: decoding its impact on HIV risk. Curr Opin HIV AIDS 2024; 19:241-245. [PMID: 38935058 PMCID: PMC11305963 DOI: 10.1097/coh.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW The penile microbiome has been linked to local inflammation and increased risk for sexually transmitted infections, including HIV. This review explores recent studies of this emerging area of HIV research. RECENT FINDINGS The male urogenital tract supports multiple distinct niches, where their associated microbiome are shaped by abiotic (e.g., oxygen, moisture) and biotic (e.g., host immunity) environmental factors and host behaviors, particularly sexual activity. In addition, male circumcision is a significant drivers of male genital microbiome in both children and adults. Recent sexual partner studies provide new insight into the exchange of genital bacteria and concurrent local immune changes that may impact HIV risk. SUMMARY The male genital microbiome is shaped by the local microenvironment and host behaviors including sexual activity. Improving our understanding of the connection between the male genital microbiome, local inflammation, and HIV susceptibility, as well as how pro-inflammatory genital bacteria are transmitted between sexual partners may inform new strategies to prevent HIV transmission.
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Affiliation(s)
- Sydney G Nelson
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Byabagambi JB, Hollingsworth B, Limmer M. Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study. BMC Public Health 2024; 24:2232. [PMID: 39152417 PMCID: PMC11329999 DOI: 10.1186/s12889-024-19796-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
Despite voluntary medical male circumcision (VMMC) being a cost-effective intervention for preventing HIV transmission, its scale-up has faced challenges. Several interventions to address these challenges in priority countries, including Uganda, have not yielded the desired results. This cross-sectional qualitative study aimed to explore the factors that affect the demand for VMMC and identify possible solutions. Semi-structured phone interviews were conducted with 29 males aged at least 18 and not more than 65 drawn randomly from a database representative of the general population maintained by an independent research organisation. Reflexive thematic analysis was conducted, and data analysis was done using NVivo version 12. The results were presented in narrative format with supporting quotes. The study received ethical and regulatory clearance to be conducted in Uganda. The average age of the respondents was 28 years. Almost all respondents had some education, and most lived in rural areas. Two themes were generated, namely, 1) deficits and opportunities for VMMC, which are issues that currently hinder the uptake of VMMC but, if addressed, would lead to better demand, and 2) pivots and shifts for VMMC, which are changes that need to be made to improve the uptake of VMMC. We found that several challenges, including myths, misconceptions, health system gaps, and uncertainties about the postoperative period, hindered the uptake of VMMC. Pivots and shifts for improving the uptake of VMMC include intensifying VMMC campaigns, addressing inequities, and addressing access barriers. We concluded that several challenges, including myths and misconceptions, health system-related gaps, and uncertainties in the post-circumcision period, persist and negatively impact the scale-up of VMMC in Uganda. VMMC beneficiaries have plausible proposals for addressing challenges. The Uganda Ministry of Health should address the myths, misconceptions, health system-related gaps, and uncertainties about the postoperative period and should involve VMMC beneficiaries in reviewing interventions to address gaps.
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Affiliation(s)
| | | | - Mark Limmer
- Department of Health Research, Lancaster University, Lancaster, UK
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Mbouche LO, Mbassi AA, Mekeme JBM, Bob DN, Ndjock JL, Tamufor EN, Tambo FM. Characteristics and management of post-circumcision Urethrocutaneous Fistula: a retrospective study in surgical units in Cameroon. BJUI COMPASS 2024; 5:681-690. [PMID: 39022657 PMCID: PMC11250727 DOI: 10.1002/bco2.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 07/20/2024] Open
Abstract
Background Urethrocutaneous fistula (UCF) is one of the major complications of circumcision. The risk factors associated with UCF are not clear-cut but its repair remains a challenge for urological surgeons. The aim of this study was to highlight the epidemiological, and clinical features and outcomes obtained from the management of UCF in the context of a country with limited medical resources where ritual circumcision is widely practiced. Patients and methods From February 2010 to December 2022, 35 patients underwent surgical repair for post-circumcision UCF in two tertiary hospitals in Yaounde, Cameroon. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu techniques were performed. Results The mean age of patients was 7.4 ± 4.1 years with a range of 2 to 21 years; the median age at circumcision was 24 months (12; 48). Most (95%) of circumcisions were performed by paramedical staff. The majority of patients (n = 26) consulted for a bifid stream, Three-quarters of fistulae were located at the corona. Small fistulae represented 74.28% (n = 26) of cases as opposed to large fistulae (25.71%). More than 70% of patients underwent a simple closure. The therapeutic results were satisfactory in 91.4% of cases (n = 32) after an average follow-up of 91.85 ± 51.92 months. There were no statistically significant differences between the patients with coronal fistula and patients with distal penile fistula concerning demographic, clinical and surgical characteristics. Conclusion Urethrocutaneous fistula is a major and frequent complication of circumcision mostly practiced by non-qualified personnel on children aged 24 months. The usual presentation is micturition with a bifid stream occurring on average 3 months after circumcision. Coronal fistulas are the commoner location. Simple closure, Thiersch-Duplay-Snodgrass and Mathieu technique appear to be safe with the advantages of low recurrence rate. An accurate diagnosis with a timeframe respecting the principles of fistula surgery combined with regular follow-up is mandatory for good long-term results with a low recurrence rate. Further prospective studies on the factors affecting the formation of urethrocutaneous fistula should be performed to prevent this complication of circumcision.
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Affiliation(s)
- Landry Oriole Mbouche
- Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco‐Obstetric and Pediatric HospitalUniversity of Yaoundé IYaoundéCameroon
| | - Achille Aurèle Mbassi
- Department of Urology, Yaoundé Central HospitalHigher Institute of Health SciencesBangangtéCameroon
| | | | - Dorcas Nyanit Bob
- Department of Pediatric Surgery, Yaoundé Central HospitalUniversity of Yaoundé IYaoundéCameroon
| | - Joseph Lionel Ndjock
- Department of Urology, Yaoundé Central HospitalHigher Institute of Health SciencesBangangtéCameroon
| | - Emmanuel Njuma Tamufor
- Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco‐Obstetric and Pediatric HospitalUniversity of Yaoundé IYaoundéCameroon
| | - Faustin Mouafo Tambo
- Department of Pediatric Surgery and subspecialties, Yaoundé Gyneco‐Obstetric and Pediatric HospitalUniversity of Yaoundé IYaoundéCameroon
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Salazar JE, Park DE, Punjani N, Pham T, Aziz M, Kigozi G, Gray RH, Kiboneka SD, Goldstein M, Li PS, Lee R, Liu CM. Comparison of the penile microbiome in infant male circumcision: Mogen clamp versus Shangring. EBioMedicine 2024; 105:105216. [PMID: 38924841 PMCID: PMC11259695 DOI: 10.1016/j.ebiom.2024.105216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/22/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND This study aimed to characterise the infant penile (coronal sulcus) microbiome and the effects of early infant male circumcision (EIMC), following a standard surgical method (Mogen Clamp) and a non-surgical alternative (ShangRing). METHODS We collected coronal sulcus swabs at baseline and on days 7 and 14 post-circumcision from infants assigned to receive EIMC by Mogen Clamp (n = 15) or ShangRing (n = 15), in a randomised trial in Rakai and Kakuuto, Uganda. We used 16S rRNA gene-based sequencing and broad-coverage qPCR to characterise the infant penile microbiome and assess the effects of EIMC in both study arms. FINDINGS Prior to EIMC, the infant penile microbiome had a mixture of facultative and strict anaerobes. In both study arms, EIMC caused penile microbiome proportional abundance changes characterised by decreases in penile anaerobes [ShangRing Prevotella: -15.0%, (SD = 19.1); Mogen clamp Prevotella: -3.6% (11.2); ShangRing Veillonella: -11.3% (17.2); Mogen clamp Veillonella: -2.6% (11.8)] and increases in skin-associated facultative anaerobes [ShangRing Corynebacterium: 24.9%, (22.4); Mogen clamp Corynebacterium: 4.7% (21.3); ShangRing Staphylococcus: 21.1% (20.5); Mogen clamp Staphylococcus: 18.1% (20.1)]. Clostridium tetani was not detected during the study. INTERPRETATION Mogen Clamp and ShangRing EIMC both changed the composition of the infant penile microbiome by reducing the proportional abundances of anaerobes and uropathogens, which is consistent with medical male circumcision findings in adults. C. tetani was not increased by either EIMC method. FUNDING Bill and Melinda Gates Foundation.
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Affiliation(s)
- Juan E Salazar
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Daniel E Park
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - Tony Pham
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Maliha Aziz
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Ronald H Gray
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Stephen D Kiboneka
- Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
| | - Marc Goldstein
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Philip S Li
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Richard Lee
- Department of Urology, Weill Cornell Medicine of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Cindy M Liu
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
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Thavarajah JJ, Hønge BL, Wejse CM. The Use of Broadly Neutralizing Antibodies (bNAbs) in HIV-1 Treatment and Prevention. Viruses 2024; 16:911. [PMID: 38932203 PMCID: PMC11209272 DOI: 10.3390/v16060911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Although antiretroviral therapy (ART) effectively halts disease progression in HIV infection, the complete eradication of the virus remains elusive. Additionally, challenges such as long-term ART toxicity, drug resistance, and the demanding regimen of daily and lifelong adherence required by ART highlight the imperative need for alternative therapeutic and preventative approaches. In recent years, broadly neutralizing antibodies (bNAbs) have emerged as promising candidates, offering potential for therapeutic, preventative, and possibly curative interventions against HIV infection. OBJECTIVE This review aims to provide a comprehensive overview of the current state of knowledge regarding the passive immunization of bNAbs in HIV-1-infected individuals. MAIN FINDINGS Recent findings from clinical trials have highlighted the potential of bNAbs in the treatment, prevention, and quest for an HIV-1 cure. While monotherapy with a single bNAb is insufficient in maintaining viral suppression and preventing viral escape, ultimately leading to viral rebound, combination therapy with potent, non-overlapping epitope-targeting bNAbs have demonstrated prolonged viral suppression and delayed time to rebound by effectively restricting the emergence of escape mutations, albeit largely in individuals with bNAb-sensitive strains. Additionally, passive immunization with bNAb has provided a "proof of concept" for antibody-mediated prevention against HIV-1 acquisition, although complete prevention has not been obtained. Therefore, further research on the use of bNAbs in HIV-1 treatment and prevention remains imperative.
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Affiliation(s)
- Jannifer Jasmin Thavarajah
- Faculty of Health, Aarhus University, 8000 Aarhus C, Denmark
- Clinical Medicine, Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark; (B.L.H.); (C.M.W.)
| | - Bo Langhoff Hønge
- Clinical Medicine, Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark; (B.L.H.); (C.M.W.)
| | - Christian Morberg Wejse
- Clinical Medicine, Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark; (B.L.H.); (C.M.W.)
- GloHAU, Center of Global Health, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark
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Gao Y, Zhan Y, Sun Y, Zheng W, Zhang W, Fu L, Guo Z, Lin YF, Li Y, Zheng L, Zhan Y, Zhu Z, Duan J, Zhang G, Huang T, Su B, Yu M, Wu G, Ouyang L, Zhao J, Wang G, Zhou Y, Qian HZ, Fitzpatrick T, Vermund SH, Zou H. Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men : A Randomized Controlled Trial. Ann Intern Med 2024; 177:719-728. [PMID: 38801778 DOI: 10.7326/m23-3317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Observational studies suggest that voluntary medical male circumcision (VMMC) may lower HIV risk among men who have sex with men (MSM). A randomized controlled trial (RCT) is needed to confirm this. OBJECTIVE To assess the efficacy of VMMC in preventing incident HIV infection among MSM. DESIGN An RCT with up to 12 months of follow-up. (Chinese Clinical Trial Registry: ChiCTR2000039436). SETTING 8 cities in China. PARTICIPANTS Uncircumcised, HIV-seronegative men aged 18 to 49 years who self-reported predominantly practicing insertive anal intercourse and had 2 or more male sex partners in the past 6 months. INTERVENTION VMMC. MEASUREMENTS Rapid testing for HIV was done at baseline and at 3, 6, 9, and 12 months. Behavioral questionnaires and other tests for sexually transmitted infections were done at baseline, 6 months, and 12 months. The primary outcome was HIV seroconversion using an intention-to-treat analysis. RESULTS The study enrolled 124 men in the intervention group and 123 in the control group, who contributed 120.7 and 123.1 person-years of observation, respectively. There were 0 seroconversions in the intervention group (0 infections [95% CI, 0.0 to 3.1 infections] per 100 person-years) and 5 seroconversions in the control group (4.1 infections [CI, 1.3 to 9.5 infections] per 100 person-years). The HIV hazard ratio was 0.09 (CI, 0.00 to 0.81; P = 0.029), and the HIV incidence was lower in the intervention group (log-rank P = 0.025). The incidence rates of syphilis, herpes simplex virus type 2, and penile human papillomavirus were not statistically significantly different between the 2 groups. There was no evidence of HIV risk compensation. LIMITATION Few HIV seroconversions and limited follow-up period. CONCLUSION Among MSM who predominantly practice insertive anal intercourse, VMMC is efficacious in preventing incident HIV infection; MSM should be included in VMMC guidelines. PRIMARY FUNDING SOURCE The National Science and Technology Major Project of China.
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Affiliation(s)
- Yanxiao Gao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, and School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (Y.G.)
| | - Yuewei Zhan
- Discipline Development Office, Shenzhen People's Hospital, Shenzhen, China (YueweiZhan)
| | - Yinghui Sun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (Y.S.)
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Zhihui Guo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Yi-Fan Lin
- Department of Spine Surgery/Orthopaedics, the First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China (Y.-F.L.)
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Lingling Zheng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (L.Z.)
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (W.Zheng, W.Zhang, L.F., Z.G., Y.L., YiqiangZhan)
| | - Zhiqiang Zhu
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Junyi Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Guanghui Zhang
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Tao Huang
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Bin Su
- Beijing Youan Hospital, Capital Medical University, Beijing, China (Z.Z., J.D., G.Z., T.H., B.S.)
| | - Maohe Yu
- Tianjin Center for Disease Control and Prevention, Tianjin, China (M.Y.)
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, China (G.Wu, L.O.)
| | - Lin Ouyang
- Chongqing Center for Disease Control and Prevention, Chongqing, China (G.Wu, L.O.)
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China (J.Z.)
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China (G.Wang)
| | - Yepeng Zhou
- Foshan Friend Care Center for AIDS/HIV Control, Foshan, China (Y.Zhou)
| | - Han-Zhu Qian
- Departments of Biostatistics and Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut (H.-Z.Q.)
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, Washington (T.F.)
| | - Sten H Vermund
- Departments of Biostatistics and Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, and Global Virus Network, Baltimore, Maryland (S.H.V.)
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China, and Shenzhen Campus, Sun Yat-sen University, Shenzhen, China (H.Z.)
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Zhang X, Li J, Tang G, Wang Z, Guo Q, Guo Q, Qin Q, Fan Y. The prevalence and factors of willingness to accept circumcision among MSM in Maanshan City, China. AIDS Care 2024; 36:752-761. [PMID: 38266488 DOI: 10.1080/09540121.2023.2299664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
To investigate the prevalence of male circumcision and the willingness to undergo male circumcision and influencing factors among MSM in Maanshan City, we conducted a cross-sectional study from June 2016 to December 2019. Respondent-driven sampling (RDS) was used to recruit participants. Influential factors of willingness to accept circumcision were identified by a multivariable logistic regression model. The multivariable logistic regression model revealed that five variables were independent influential factors for willingness to participate. The factors include that used condoms during last anal intercourse (OR = 1.87, 95% CI:1.03-3.41, P = 0.04), sex with female sex partners (OR = 0.499, 95% CI:0.298-0.860, P = 0.012, level of education (junior college: OR = 0.413, 95% CI:0.200-0.854, P = 0.017; bachelor's degree or higher: OR = 0.442, 95% CI:0.208-0.938, P = 0.033), condom use during oral sex in the last six months (OR = 4.20, 95% CI:1.47-12.0, P = 0.007) and level of knowledge of PrEP (OR = 5.09, 95% CI:1.39-18.7, P = 0.014). Given the willingness of MSM to accept circumcision was low in China, establishing a proper understanding of circumcision is essential if it is to be used as a strategy to prevent HIV infection among MSM. Therefore, publicity and education on the operation should be strengthened to increase the willingness to undergo male circumcision.
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Affiliation(s)
- Xinhong Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Jianwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
| | - Gan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Ziwei Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Qian Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Qisheng Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Qirong Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Ma'anshan Center for Disease Control and Prevention, Ma'anshan, People's Republic of China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
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Agot K, Onyango J, Otieno G, Musingila P, Gachau S, Ochillo M, Grund J, Joseph R, Mboya E, Ohaga S, Omondi D, Odoyo-June E. Shifting reasons for older men remaining uncircumcised: Findings from a pre- and post-demand creation intervention among men aged 25-39 years in western Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003188. [PMID: 38820408 PMCID: PMC11142559 DOI: 10.1371/journal.pgph.0003188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/04/2024] [Indexed: 06/02/2024]
Abstract
Voluntary medical male circumcision (VMMC) reduces men's risk of acquiring Human immunodeficiency virus (HIV) through vaginal sex. However, VMMC uptake remains lowest among Kenyan men ages 25-39 years among whom the impact on reducing population-level HIV incidence was estimated to be greatest at the start of the study in 2014. We conducted a pre- and post-intervention survey as part of a cluster randomized controlled trial to determine the effect of two interventions (interpersonal communication (IPC) and dedicated service outlets (DSO), delivered individually or together) on improving VMMC uptake among men ages 25-39 years in western Kenya between 2014 and 2016. The study had three intervention arms and a control arm. In arm one, an IPC toolkit was used to address barriers to VMMC. In arm two, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO. The control arm had standard of care. At baseline, uncircumcised men ranked the top three reasons for remaining uncircumcised. An IPC demand creation toolkit was used to address the identified barriers and men were referred for VMMC at study-designated facilities. At follow-up, those who remained uncircumcised were again asked to rank the top three reasons for not getting circumcised. There was inconsistency in ranking of reported barriers at pre- and post- intervention: 'time/venue not convenient' was ranked third at baseline and seventh at follow-up; 'too busy to go for circumcision' was tenth at baseline but second at follow-up, and concern about 'what I/family will eat' was ranked first at both baseline and follow-up, but the proportion reduced from 62% to 28%. Men ages 25-39 years cited a variety of logistical and psychosocial barriers to receiving VMMC. After exposure to IPC, most of these barriers shifted while some remained the same. Additional innovative interventions to address on-going and shifting barriers may help improve VMMC uptake among older men.
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Affiliation(s)
- Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - George Otieno
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Paul Musingila
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Susan Gachau
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | - Jonathan Grund
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Rachael Joseph
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Edward Mboya
- Impact Research and Development Organization, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Dickens Omondi
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV and TB (DGHT), Center for Global Health (CGH), US Centers for Disease Control and Prevention, Kisumu, Kenya
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Awuoche HC, Joseph RH, Magut F, Khagayi S, Odongo FS, Otieno M, Appolonia A, Odoyo-June E, Kwaro DO. Prevalence and risk factors of sexually transmitted infections in the setting of a generalized HIV epidemic-a population-based study, western Kenya. Int J STD AIDS 2024; 35:418-429. [PMID: 38240604 PMCID: PMC11047016 DOI: 10.1177/09564624241226487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/09/2023] [Accepted: 12/29/2023] [Indexed: 04/28/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) cause adverse health outcomes, including increasing HIV acquisition/transmission risk. We analyzed data from an HIV biomarker and behavioral survey to estimate STI prevalence, and explore associated factors in the setting of a generalized HIV epidemic in Siaya County, western Kenya. METHODS Data were collected in March-September 2022 through face-to-face interviews using structured questionnaires; records from 9643 sexually active participants aged 13+ years were included in the analysis. We calculated weighted self-reported STI prevalence, by sex, age, and HIV status and explored associated factors using multivariable logistic regression. RESULTS Median age was 37 years and 59.9% were female; HIV prevalence was 18.0%. Overall STI prevalence was 1.8%; 1.5-fold higher among males vs. females, and 2.6-fold higher among participants living with HIV vs. those without. HIV status and multiple sexual partners were independently associated with STI in both sexes. Mind-altering substance use and being circumcised were associated with STI among males. CONCLUSIONS This study estimates STI prevalence in the setting of high HIV prevalence. Findings underscore the importance of: effective STI screening in HIV clinics and HIV testing and counseling in STI clinics; screening and counseling on substance use, and HIV pre-exposure prophylaxis; and intensive sexual health counseling in male circumcision programmes.
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Affiliation(s)
- Hellen Carolyne Awuoche
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Rachael H Joseph
- United States Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Faith Magut
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Fredrick S Odongo
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Moses Otieno
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Aoko Appolonia
- United States Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Elijah Odoyo-June
- United States Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Daniel O Kwaro
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
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10
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Masango BZ, Ferrandiz-Mont D, Chiao C. Voluntary medical male circumcision and educational gradient in relation to HIV infection among sexually active adult men in Eswatini: evidence from the national surveys in 2006-2007 and 2016. Int Health 2024; 16:208-218. [PMID: 37702181 PMCID: PMC10911536 DOI: 10.1093/inthealth/ihad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/01/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND To address knowledge gaps, this study examined social determinants, such as education attainment and HIV prevention, among sexually active men (SAM), with a focus on voluntary medical male circumcision (VMMC). METHODS Two nationally representative surveys, the Eswatini Demographic and Health Survey 2006 and the Eswatini HIV Incidence Measurement Survey 2016, were used to estimate whether or not VMMC at the individual and community levels contributes to HIV disparities to any meaningful extent. Multilevel logistic regression models further explored the educational gradient in HIV infection for 2006-2007 and 2016 with regard to VMMC among SAM, while adjusting for household poverty, sexual practices and individual characteristics. RESULTS Among SAM with tertiary education, HIV prevalence declined from 25.0% in 2006-2007 to 10.5% in 2016. A 51% decrease in HIV prevalence was found to be associated with an increase in VMMC (adjusted odds ratio 0.49; 95% CI 0.40 to 0.60). Compared with SAM with tertiary education, those who had a lower level of education were more likely to have HIV infection and this education gradient effect had become particularly profound in 2016. CONCLUSIONS VMMC began to be promoted in 2008 in Eswatini and results suggest its effect, along with the education attainment effect, significantly resulted in a meaningful reduction in HIV prevalence among SAM by 2016.
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Affiliation(s)
| | - David Ferrandiz-Mont
- Public Health Surveillance and Emergency Response Department of Vallès Occidental and Vallès Oriental, Public Health Agency of Catalonia, Sant Cugat del Vallès, Barcelona 08173, Spain
| | - Chi Chiao
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan, ROC
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11
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Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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12
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Weiss SM, Bowa K, Zulu R, Rodriguez VJ, Cook RR, Jones DL. Dissemination and implementation of an evidence-based voluntary medical male circumcision program: The Spear & Shield program. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002065. [PMID: 38295087 PMCID: PMC10830021 DOI: 10.1371/journal.pgph.0002065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
Despite compelling evidence linking voluntary medical male circumcision (VMMC) with 60-70% HIV risk reduction in sub-Saharan Africa, Zambian men have been especially reluctant to undergo VMMC. The Government of Zambia set targets for VMMC uptake and promoted community-level interventions. Spear & Shield (S&S) is an innovative, evidence-based, service program promoting VMMC uptake while ensuring both VMMC supply and demand. This study assessed the large-scale provincial rollout of the program (S&S2) utilizing the RE-AIM model for translating interventions into the community. The S&S2 study was conducted between November 2015 and December 2020, and sequentially rolled out over four Zambian provinces in 96 clinics; 24 observation clinics received VMMC training only. Local clinic healthcare workers were trained to conduct the VMMC procedure and HIV counselors were trained to lead S&S group sessions. Using the RE-AIM model, primary outcomes were: Reach, the number, proportion, and representativeness of S&S attendees; Effectiveness, the impact of S&S2 on VMMC uptake; Adoption, the number, proportion, and representativeness of clinics implementing S&S2; Implementation, fidelity to the S&S intervention manual; and Maintenance, the extent to which S&S2 became an element of standard care within community clinics. Initially, n = 109 clinics were recruited; 96 were sustained and randomized for activation (Adoption). A total of 45,630 clinic patients (n = 23,236 men and n = 22,394 women) volunteered to attend the S&S sessions (Reach). The S&S2 program ran over 2,866 clinic-months (Implementation). Although the study did not target individual-level VMMCs, ~58,301 additional VMMCs were conducted at the clinic level (Effectiveness). Fidelity to the S&S intervention by group leaders ranged from 42%-95%. Sustainability of the program was operationalized as the number of CHCs initially activated that sustained the program. Intervention delivery ended, however, when study funding ceased (Maintenance). The S&S2 program successfully utilized the RE-AIM model to achieve study goals for implementation and dissemination in four Zambian provinces. Innovative VMMC programs such as S&S2 can improve the uptake of VMMC, one of the most effective strategies in the HIV prevention arsenal.
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Affiliation(s)
- Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Kasonde Bowa
- Clinical Sciences Department University of Lusaka, Lusaka, Zambia
| | - Robert Zulu
- Ministry of Health, Provincial Health Office, Ndola, Copperbelt, Zambia
- Department of Health Promotion and Education, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Psychology, University of Georgia, Athens, Georgia, United States of America
| | - Ryan R. Cook
- Medicine, General Internal Medicine, and Geriatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Thomas ML, Zuma K, Loykissoonlal D, Dube ZB, Vranken P, Porter SE, Kripke K, Seatlhodi T, Meyer-Rath G, Johnson LF, Imai-Eaton JW. Substantial but spatially heterogeneous progress in male circumcision for HIV prevention in South Africa. COMMUNICATIONS MEDICINE 2024; 4:1. [PMID: 38172187 PMCID: PMC10764768 DOI: 10.1038/s43856-023-00405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Voluntary medical male circumcision (VMMC) reduces the risk of male HIV acquisition by 60%. Programmes to provide VMMCs for HIV prevention have been introduced in sub-Saharan African countries with high HIV burden. Traditional circumcision is also a long-standing male coming-of-age ritual, but practices vary considerably across populations. Accurate estimates of circumcision coverage by age, type, and time at subnational levels are required for planning and delivering VMMCs to meet targets and evaluating their impacts on HIV incidence. METHODS We developed a Bayesian competing risks time-to-event model to produce region-age-time-type specific probabilities and coverage of male circumcision with probabilistic uncertainty. The model jointly synthesises data from household surveys and health system data on the number of VMMCs conducted. We demonstrated the model using data from five household surveys and VMMC programme data to produce estimates of circumcision coverage for 52 districts in South Africa between 2008 and 2019. RESULTS Nationally, in 2008, 24.1% (95% CI: 23.4-24.8%) of men aged 15-49 were traditionally circumcised and 19.4% (18.9-20.0%) were medically circumcised. Between 2010 and 2019, 4.25 million VMMCs were conducted. Circumcision coverage among men aged 15-49 increased to 64.0% (63.2-64.9%) and medical circumcision coverage to 42% (41.3-43.0%). Circumcision coverage varied widely across districts, ranging from 13.4 to 86.3%. The average age of traditional circumcision ranged between 13 and 19 years, depending on local cultural practices. CONCLUSION South Africa has made substantial, but heterogeneous, progress towards increasing medical circumcision coverage. Detailed subnational information on coverage and practices can guide programmes to identify unmet need to achieve national and international targets.
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Affiliation(s)
- Matthew L Thomas
- Department of Earth and Environmental Sciences, University of Manchester, Manchester, UK.
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Khangelani Zuma
- Human and Social Capabilities Research Division, Human Sciences Research Council, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Peter Vranken
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sarah E Porter
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - Thapelo Seatlhodi
- National Department of Health, Pretoria, South Africa
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jeffrey W Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Perkins JM, Kakuhikire B, Baguma C, Jeon S, Walker SF, Dongre R, Kyokunda V, Juliet M, Satinsky EN, Comfort AB, Siedner MJ, Ashaba S, Tsai AC. Male circumcision uptake and misperceived norms about male circumcision: Cross-sectional, population-based study in rural Uganda. J Glob Health 2023; 13:04149. [PMID: 38112224 PMCID: PMC10731132 DOI: 10.7189/jogh.13.04149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Background Over the past decade, 15 high-priority countries in eastern and southern Africa have promoted voluntary medical male circumcision for human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevention. The prevalence of male circumcision in Uganda nearly doubled from 26% in 2011 to 43% in 2016, but remains below the 2020 target level. Little is known about how common male circumcision is perceived to be, how accurate such perceptions are, and whether they are associated with men's own circumcision uptake. Methods We conducted a cross-sectional study of all adult residents of eight villages in Rwampara District, southwestern Uganda in 2020-2022. We elicited their perceptions of the adult male circumcision prevalence within their village: >50% (most men), 10% to <50% (some), <10%, (few to none), or do not know. We compared their perceived norms to the aggregated prevalence of circumcision reported in these villages. We used a modified multivariable Poisson regression model to estimate the association between perceived norms and personal circumcision uptake among men. Results We surveyed 1566 participants (91% response rate): 698 men and 868 women. Among the men, 167 (27%) reported being circumcised, including 167/444 (38%) men <50 years of age. Approximately one-fourth of the population (189 (27%) men and 177 (20%) women) believed that few to no men in their own village had been circumcised. In a multivariable regression model, men who underestimated the prevalence of male circumcision were less likely to be circumcised themselves (adjusted relative risk (aRR) = 0.51; 95% confidence interval (CI) = 0.37-0.83). Conclusions In this population-based study in rural Uganda, one-fourth of men underestimated the prevalence of male circumcision. Men who underestimated the extent of circumcision uptake were themselves less likely to be circumcised. If the observed association is causal and underestimates within the population contribute to low uptake, then interventions correcting these misperceived norms could increase uptake of voluntary medical male circumcision.
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Affiliation(s)
- Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sehee Jeon
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Sarah F Walker
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Rohit Dongre
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alison B Comfort
- Bixby Center for Global Reproductive Health, University of California, San Franciso, California, USA
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Nyambah PK, Agjei R, Sarfo B. Seroprevalence and factors associated with Hepatitis B virus infection among students in two senior high schools in the Krachi Nchumuru district in Ghana-A cross-sectional study. BMC Res Notes 2023; 16:358. [PMID: 38042854 PMCID: PMC10693693 DOI: 10.1186/s13104-023-06624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/12/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND There is paucity of hepatitis B virus (HBV) data among student populations although Ghana is HBV endemic. Screening and identification of factors associated with HBV transmission in schools will support the intervention in the elimination of the virus by 2030. This study assessed the seroprevalence and factors associated with HBV among students in two Senior High Schools in the Krachi Nchumuru District in Ghana. METHODS Through cross-sectional design and simple random sampling technique, 300 first-year students were enrolled from selected Senior High Schools. Structured questionnaires were used to collect data on demographic and exposure factors while rapid test kit was used to detect HBV infections. Chi-square/Fisher exact test and multivariable logistic regression were performed to determine the association between the variables at a 95% confidence interval and 0.05 significant level. RESULTS Seroprevalence of HBV was 14% (42/300) among the students. The prevalence was significantly (p = 0.001) higher in males 19.4% (34/175) than females 6.4% (8/125). 77.7% (233/300) were aware of HBV infection. Males who were circumcised were 4 times more likely to be infected with HBV (AOR = 4.09, 95%CI = 1.82-9.19) (p = 0.001) compared with those uncircumcised. CONCLUSION HBV screening and education on hygienic genital circumcision practices must be prioritized in endemic countries.
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Affiliation(s)
- Patrick K Nyambah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, P.O. Box 13, Legon-Accra, Ghana
- Health Directorate, P.O. Box 79, Kyinderi, Krachi Nchumuru District, Ghana
| | - Richard Agjei
- Department of Health Administration and Education, University of Education, Winneba, Central Region, Ghana
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, P.O. Box 13, Legon-Accra, Ghana.
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Ntshiqa T, Musekiwa A, Manesen R, Mdose H, Ngoma N, Kuonza L, Dlamini T, Reddy C, Williams S. Knowledge, Attitudes, Practices, and Acceptability of Medical Male Circumcision among Males in Traditionally Circumcising Rural Communities of Alfred Nzo District, Eastern Cape, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7091. [PMID: 38063521 PMCID: PMC10706319 DOI: 10.3390/ijerph20237091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023]
Abstract
Male circumcision (MC) reduces HIV transmission risk by up to 60% in heterosexual men. However, uptake of medical male circumcision (MMC) is low in traditionally circumcising communities of South Africa. We assessed knowledge, attitudes, and practices to identify factors predicting acceptability of MMC among males in the Alfred Nzo District. A cross-sectional study was conducted among males aged 15-49 years in this district. Logistic regression was used to identify factors predicting acceptability of MMC. We interviewed 343 males who had a median age of 19 years (interquartile range (IQR): 16-25 years). Of these, 77% (95% confidence interval (CI): 72-82) were circumcised: 77% (95% CI: 71-82) were circumcised in a traditional setting and 21% (95% CI: 16-26) in a medical setting. The median score of knowledge about the benefits of MMC was 62.5% (IQR: 37.5-75.0), with 59% (95% CI: 53-64) demonstrating a positive attitude towards MMC and 68% (95% CI: 63-73) accepting involvement of health workers in MC. Excellent knowledge (adjusted odds ratio (aOR): 3.07, 95% CI: 0.99-9.58, p = 0.053), awareness (aOR: 3.26, 95% CI: 1.08-9.86, p = 0.037), and positive attitude towards MMC (aOR: 2.35, 95% CI: 1.30-4.25, p = 0.005) were associated with acceptability of MMC. Participants demonstrated good knowledge and acceptance of the MMC programme. Knowledge, attitude, and awareness were significant predictors of MMC acceptability.
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Affiliation(s)
- Thobani Ntshiqa
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- South African National Aids Council, Pretoria 0002, South Africa
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
- The Aurum Institute, Johannesburg 2193, South Africa;
| | - Alfred Musekiwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Riyadh Manesen
- The Aurum Institute, Johannesburg 2193, South Africa;
- GERMS-SA, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa
- Epidemiology Unit, Eastern Cape Department of Health, Bisho 5605, South Africa;
| | - Hetani Mdose
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Nqobile Ngoma
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
| | - Thomas Dlamini
- Epidemiology Unit, Eastern Cape Department of Health, Bisho 5605, South Africa;
| | - Carl Reddy
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0002, South Africa
- TEPHINET Secretariat, The Task Force for Global Health, Decatur, GA 30030, USA
| | - Seymour Williams
- South African Field Epidemiology Training Programme, National Institute for Communicable Disease, Sandringham, Johannesburg 2131, South Africa; (A.M.); (H.M.); (N.N.); (L.K.); (C.R.); (S.W.)
- Centers for Disease Control and Prevention, Atlanta, GA 30328, USA
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17
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O'Bryan G, Ensminger A, Billah I, Sithole E, Nghatanga M, Brandt L, Shepard M, Aupokolo M, Mengistu AT, Forster N, Zemburuka B, Mutandi G, Barnhart S, O'Malley G, Feldacker C. Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis. BMC Health Serv Res 2023; 23:1044. [PMID: 37773121 PMCID: PMC10543846 DOI: 10.1186/s12913-023-10016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Surgical voluntary medical male circumcision (VMMC) is a safe procedure; however, maintaining quality standards at scale, particularly during scale-up, is a challenge making ongoing quality management (QM) efforts essential. This study describes program quality measured by rates of adverse events (AEs) over four years of VMMC implementation in Namibia, compares AE rates over time, and discusses QM processes that contextualize AE trends and illustrate improvements in quality as the program matured. The International Training and Education Center for Health (I-TECH) assisted the Namibian Ministry of Health and Social Services (MoHSS) in expanding VMMC in three regions among boys and men over 10 years of age between January 2015 and September 2019. METHODS A comprehensive package of QM strategies was implemented by multi-disciplinary onsite teams with support from national and international technical advisors. Retrospective routine MoHSS data from the VMMC register, client forms, and monthly AE reports were collected during implementation in the three regions to assess the impact of QM interventions on AEs and to calculate the proportion of clients who experienced AEs over time. The proportion of clients who experienced an AE over time was compared using a Cochran-Armitage test for trend. RESULTS Between January 2015 and September 2019, 40,336 clients underwent VMMC and 593 (1.5%) clients experienced a post-operative AE in the three supported regions. The AE rate was highest in the first quarter of clinical service delivery in each region (January-March 2015 in Oshana and Zambezi, October-December 2017 in //Kharas) but declined over the implementation period as the program matured. This observed trend between program maturity and declining AE rates over time was significant (p < 0.001) when compared using a Cochran-Armitage test for trend. CONCLUSIONS As the I-TECH-supported VMMC program matured, QM measures were introduced and routinized, and clinical quality improved over time with the rate of AEs decreasing significantly over the implementation period. Applying systematic and continuous QM processes and approaches across the continuum of VMMC services and considering local context can contribute to increased clinical safety. QM measures that are established in more mature program sites can be quickly adopted to respond to quality issues in program expansion sites.
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Affiliation(s)
- Gillian O'Bryan
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Alison Ensminger
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Idel Billah
- International Training and Education Center for Health (I-TECH), Windhoek, Namibia
| | - Edwin Sithole
- Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia
| | - Magdaleena Nghatanga
- International Training and Education Center for Health (I-TECH), Windhoek, Namibia
| | - Laura Brandt
- Department of Global Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), Windhoek, Namibia
| | - Mark Shepard
- Department of Global Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), Windhoek, Namibia
| | - Mekondjo Aupokolo
- Directorate of Special Programmes-Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Norbert Forster
- Department of Global Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health (I-TECH), Windhoek, Namibia
| | - Brigitte Zemburuka
- Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia
| | - Gram Mutandi
- Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia
| | - Scott Barnhart
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gabrielle O'Malley
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Caryl Feldacker
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Bernaschina-Rivera SA, López-Chaim AI, Cordero-Pacheco JA, Fernández-Crespo R, Quesada-Olarte J, Carrión R. Circumcision and Sexual Medicine. Sex Med Rev 2023; 11:412-420. [PMID: 37085961 DOI: 10.1093/sxmrev/qead009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/26/2023] [Accepted: 02/18/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Male circumcision is one of the most frequently performed and debated urological procedures due to its possible implications for sexual health. OBJECTIVES The objective of this article is to review the literature on male circumcision and reconcile the scientific evidence to improve the quality of care, patient education, and clinician decision-making regarding the effects on sexual function of this procedure. METHODS A review of the published literature regarding male circumcision was performed on PubMed. The criteria for selecting resources prioritized systematic reviews and cohort studies pertinent to sexual dysfunction, with a preference for recent publications. RESULTS Despite the conflicting data reported in articles, the weight of the scientific evidence suggests there is not sufficient data to establish a direct association between male circumcision and sexual dysfunction. CONCLUSION This review provides clinicians with an updated summary of the best available evidence on male circumcision and sexual dysfunction for evidenced-based quality of care and patient education.
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Affiliation(s)
| | | | | | - Raúl Fernández-Crespo
- University of South Florida, Morsani College of Medicine, Tampa, FL 33602, United States
| | - José Quesada-Olarte
- University of South Florida, Morsani College of Medicine, Tampa, FL 33602, United States
| | - Rafael Carrión
- University of South Florida, Morsani College of Medicine, Tampa, FL 33602, United States
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Peck ME, Bronson M, Djomand G, Basile I, Collins K, Kankindi I, Kayirangwa E, Malamba SS, Mugisha V, Nsanzimana S, Remera E, Kazaura KJ, Amuri M, Mmbando S, Mgomella GS, Simbeye D, Colletar Awor A, Biraro S, Kabuye G, Kirungi W, Chituwo O, Hanunka B, Kamboyi R, Mulenga L, Musonda B, Muyunda B, Nkumbula T, Malaba R, Mandisarisa J, Musuka G, Peterson AE, Toledo C. HIV, syphilis, and hepatitis B virus infection and male circumcision in five Sub-Saharan African countries: Findings from the Population-based HIV Impact Assessment surveys, 2015-2019. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002326. [PMID: 37721926 PMCID: PMC10506706 DOI: 10.1371/journal.pgph.0002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/06/2023] [Indexed: 09/20/2023]
Abstract
Voluntary medical male circumcision (VMMC) has primarily been promoted for HIV prevention. Evidence also supports that male circumcision offers protection against other sexually transmitted infections. This analysis assessed the effect of circumcision on syphilis, hepatitis B virus (HBV) infection and HIV. Data from the 2015 to 2019 Population-based HIV Impact Assessments (PHIAs) surveys from Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were used for the analysis. The PHIA surveys are cross-sectional, nationally representative household surveys that include biomarking testing for HIV, syphilis and HBV infection. This is a secondary data analysis using publicly available PHIA data. Univariate and multivariable logistic regression models were created using pooled PHIA data across the five countries to assess the effect of male circumcision on HIV, active and ever syphilis, and HBV infection among sexually active males aged 15-59 years. Circumcised men had lower odds of syphilis infection, ever or active infection, and HIV, compared to uncircumcised men, after adjusting for covariates (active syphilis infection = 0.67 adjusted odds ratio (aOR), 95% confidence interval (CI), 0.52-0.87, ever having had a syphilis infection = 0.85 aOR, 95% CI, 0.73-0.98, and HIV = 0.53 aOR, 95% CI, 0.47-0.61). No difference between circumcised and uncircumcised men was identified for HBV infection (P = 0.75). Circumcised men have a reduced likelihood for syphilis and HIV compared to uncircumcised men. However, we found no statistically significant difference between circumcised and uncircumcised men for HBV infection.
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Affiliation(s)
- Megan E. Peck
- Division of Global HIV & TB, HIV Prevention Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Megan Bronson
- Division of Global HIV & TB, Epidemiology and Surveillance Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Gaston Djomand
- Division of Global HIV & TB, HIV Prevention Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Ikuzo Basile
- Ministry of Health, Rwanda Biomedical Center, Kigali City, Rwanda
| | | | - Ida Kankindi
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Eugenie Kayirangwa
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Samuel S. Malamba
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kigali, Rwanda
| | | | - Sabin Nsanzimana
- Ministry of Health, Rwanda Biomedical Center, Kigali City, Rwanda
| | - Eric Remera
- Ministry of Health, Rwanda Biomedical Center, Kigali City, Rwanda
| | - Kokuhumbya J. Kazaura
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Mbaraka Amuri
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Susan Mmbando
- National AIDS Control Program, Ministry of Health, Dar-es-Salaam, Tanzania
| | - George S. Mgomella
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Daimon Simbeye
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Dar-es-Salaam, Tanzania
| | - Anna Colletar Awor
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Geoffrey Kabuye
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Omega Chituwo
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Brave Hanunka
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Royd Kamboyi
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Lloyd Mulenga
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Bupe Musonda
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Brian Muyunda
- Division of Global HIV & TB, Centers for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Rickie Malaba
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - John Mandisarisa
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Amy E. Peterson
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Carlos Toledo
- Division of Global HIV & TB, HIV Prevention Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States of America
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Rametse CL, Webb EL, Herrera C, Alinde B, Besethi A, Motaung B, Mbangiwa T, Leach L, Sebaa S, Pillay ADA, Seiphetlo TB, Malhangu B, Petkov S, Else L, Mugaba S, Namubiru P, Odoch G, Opoka D, Serwanga J, Ssemata AS, Kaleebu P, Khoo S, Lebina L, Martinson N, Chiodi F, Fox J, Gray CM. A randomized clinical trial of on-demand oral pre-exposure prophylaxis does not modulate lymphoid/myeloid HIV target cell density in the foreskin. AIDS 2023; 37:1651-1659. [PMID: 37289572 PMCID: PMC11175721 DOI: 10.1097/qad.0000000000003619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES As topical pre-exposure prophylaxis (PrEP) has been shown to cause immune modulation in rectal or cervical tissue, our aim was to examine the impact of oral PrEP on lymphoid and myeloid changes in the foreskin in response to dosing and timing of drug administration. DESIGN HIV-negative male individuals ( n = 144) were recruited in South Africa and Uganda into an open-label randomized controlled trial in a 1 : 1 : 1 : 1 : 1 : 1 : 1 : 1 : 1 ratio to control arm (with no PrEP) or one of eight arms receiving emtricitabine-tenofovir disoproxil fumarate (F/TDF) or emtricitabine-tenofovir alafenamide (F/TAF) at one of two different doses, 5 or 21 h before undergoing voluntary medical male circumcision (VMMC). METHODS After dorsal-slit circumcision, foreskin tissue sections were embedded into Optimal Cutting Temperature media and analysed, blinded to trial allocation, to determine numbers of CD4 + CCR5 + , CD1a + cells and claudin-1 expression. Cell densities were correlated with tissue-bound drug metabolites and p24 production after ex-vivo foreskin challenge with HIV-1 bal . RESULTS There was no significant difference in CD4 + CCR5 + or CD1a + cell numbers in foreskins between treatment arms compared with the control arm. Claudin-1 expression was 34% higher ( P = 0.003) in foreskin tissue from participants receiving PrEP relative to controls, but was no longer statistically significant after controlling for multiple comparisons. There was neither correlation of CD4 + CCR5 + , CD1a + cell numbers, or claudin-1 expression with tissue-bound drug metabolites, nor with p24 production after ex-vivo viral challenge. CONCLUSION Oral doses and timing of on-demand PrEP and in-situ drug metabolite levels in tissue have no effect on numbers or anatomical location of lymphoid or myeloid HIV target cells in foreskin tissue.
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Affiliation(s)
- Cosnet L. Rametse
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Emily L. Webb
- Medical Research Council (MRC) International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine
| | - Carolina Herrera
- Department of Infectious Disease, Imperial College London, London, UK
| | - Berenice Alinde
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Asiphe Besethi
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Bongani Motaung
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Tshepiso Mbangiwa
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Lloyd Leach
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Cape Town, South Africa
| | - Shorok Sebaa
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Azure-Dee A.P. Pillay
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Thabiso B. Seiphetlo
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Boitshoko Malhangu
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Stefan Petkov
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Laura Else
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - Susan Mugaba
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Patricia Namubiru
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Geoffrey Odoch
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Daniel Opoka
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jennifer Serwanga
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew S. Ssemata
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- MRC/Uganda Virus Research Institute/London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Saye Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - Limakatso Lebina
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Neil Martinson
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Clive M. Gray
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Biomedical Research Institute, Stellenbosch University, Cape Town, South Africa
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21
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Weiss SM, Rodriguez VJ, Cook RR, Bowa K, Zulu R, Mweemba O, Kamboyi R, Castro J, Dunleavy VO, Alcaide ML, Jones DL. Increasing early infant male circumcision uptake in Zambia: Like father like son. PLoS One 2023; 18:e0289819. [PMID: 37561707 PMCID: PMC10414584 DOI: 10.1371/journal.pone.0289819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
Voluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, "Like Father, Like Son" (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples' older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son "bonding" by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples' older sons and is a novel leverage point for promotion of this HIV prevention strategy.
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Affiliation(s)
- Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Psychology, University of Georgia, Athens, Georgia, United States of America
| | - Ryan R. Cook
- Medicine, General Internal Medicine, and Geriatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Kasonde Bowa
- University of Lusaka School of Medicine, Lusaka, Zambia
| | - Robert Zulu
- University of Zambia School of Medicine, Lusaka, Zambia
| | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Jose Castro
- Division of Infectious Diseases, Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | | | - Maria L. Alcaide
- Division of Infectious Diseases, Dept. of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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22
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Skalland T, Ayles H, Bock P, Bwalya J, Shanaube K, Kasese N, Dupré M, Kosloff B, Floyd S, Wilson E, Moore A, Eshleman S, Fidler S, Hayes R, Donnell D. Community- and individual-level correlates of HIV incidence in HPTN 071 (PopART). J Int AIDS Soc 2023; 26:e26155. [PMID: 37643290 PMCID: PMC10465013 DOI: 10.1002/jia2.26155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Universal HIV testing and treatment aims to identify all people living with HIV and offer them treatment, decreasing the number of individuals with unsuppressed HIV and thus reducing HIV transmission. Longitudinal follow-up of individuals with and without HIV in a cluster-randomized trial of communities allowed for the examination of community- and individual-level measures of HIV risk and HIV incidence. METHODS HPTN 071 (PopART) was a three-arm cluster-randomized trial conducted between 2013 and 2018 that evaluated the use of two combination HIV prevention strategies implemented at the community level to reduce HIV incidence compared to the standard of care. The trial, conducted in 21 communities in Zambia and South Africa, measured HIV incidence over 36 months in a population cohort of ∼2000 randomly selected adults per community aged 18-44. Multilevel models were used to assess the association between HIV incidence and community- and individual-level socio-demographic and behavioural risk factors, as well as prevalence of detectable virus (PDV) defined as the estimated proportion of the community with unsuppressed viral load. RESULTS Overall HIV incidence was 1.49/100 person-years. Communities with less financial wealth and communities with more individuals reporting having sex partners outside of the community or two or more sexual partners had higher HIV incidence. PDV at 2 years of study was 6.8% and was strongly associated with HIV incidence: for every 50% relative reduction in community PDV, there was a 49% (95% confidence interval [CI]: 37%-58%, p < 0.001) relative decrease in HIV incidence. At the individual level; socio-economic status, AUDIT score, medical male circumcision and certain sexual behaviours were associated with HIV risk. CONCLUSIONS Using data from the PopART randomized trial, we found several associations of HIV incidence with community-level measures reflecting the sexual behaviour and socio-economic make-up of each community. We also found a strong association between community PDV and HIV incidence supporting the use of PDV as a tool for monitoring progress in controlling the epidemic. Lastly, we found significant individual-level factors of HIV risk that are generally consistent with previous HIV epidemiological research. These results have the potential to identify high high-incidence communities, inform structural-level interventions, and optimize individual-level interventions for HIV prevention. CLINICAL TRIAL NUMBER ClinicalTrials.gov number, NCT01900977, HPTN 071 [PopArt].
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Affiliation(s)
| | - Helen Ayles
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Peter Bock
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Justin Bwalya
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Kwame Shanaube
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Nkatya Kasese
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Michelle Dupré
- Desmond Tutu TB CentreDepartment of Paediatrics and Child HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Barry Kosloff
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Sian Floyd
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
| | - Ethan Wilson
- Fred Hutchinson Cancer CenterSeattleWashingtonUSA
| | | | - Susan Eshleman
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Sarah Fidler
- UK Department of Infectious DiseaseFaculty of Medicine, Imperial College NIHR BRCLondonUK
| | - Richard Hayes
- ZambartLusakaZambia
- London School of Hygiene and Tropical MedicineLondonUK
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23
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Guiton R, Drevet JR. Viruses, bacteria and parasites: infection of the male genital tract and fertility. Basic Clin Androl 2023; 33:19. [PMID: 37468865 DOI: 10.1186/s12610-023-00193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Infertility affects one couple out of six worldwide. Male infertilty can result from congenital or acquired factors, of which pathogens that reach the genital tract through sexual contact or blood dissemination. The impact of major viral, bacterial and parasitic infections on the male genital tract and fertility has been summarized. RESULTS AND CONCLUSIONS A systematic review of articles published in the Google Scholar and PubMed databases was conducted. It turns out that viruses, as well as bacteria and parasites are major inducers of male genital tract infections and ensuing infertility through damage to the organs and subsequent loss of function and/or through direct damage to the sperm cells. Moreover, not only male infertility results from such infections but these can also be transmitted to women and even to the offspring, thus highlighting the need to efficiently detect, treat and prevent them.
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Affiliation(s)
- Rachel Guiton
- Université Clermont Auvergne, CNRS UMR6293, GReD Institute, 63001, Clermont-Ferrand, France.
| | - Joël R Drevet
- Université Clermont Auvergne, CNRS UMR6293, GReD Institute, 63001, Clermont-Ferrand, France
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24
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Kiboneka S, Anok A, Nakabuye R, Odiya S, Magembe J, Nazziwa R, Ddamulira C, Mulooki A, Galiwango RM, Watya S, Li PS, Lee RK, Gray RH, Kigozi G, Kankaka EN. Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda. BJUI COMPASS 2023; 4:423-429. [PMID: 37334019 PMCID: PMC10268568 DOI: 10.1002/bco2.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives The objective of this study is to determine the optimal timing for device-based infant circumcision under topical anaesthesia. Subjects/patients We include infants aged 1-60 days who were enrolled in a field study of the no-flip ShangRing device at four hospitals in the Rakai region of south-central Uganda, between 5 February 2020 and 27 October 2020. Methods Two hundred infants, aged 0-60 days, were enrolled, and EMLA cream was applied on the foreskin and entire penile shaft. The anaesthetic effect was assessed every 5 min by gentle application of artery forceps at the tip of the foreskin, starting at 10 min post-application until 60 min, the recommended time to start circumcision. The response was measured using the Neonatal Infant Pain Scale (NIPS). We determined the onset and duration of anaesthesia (defined as <20% of infants with NIPS score >4) and maximum anaesthesia (defined as <20% of infants with NIPS score >2). Results Overall, NIPS scores decreased to a minimum and reversed before the recommended 60 min. Baseline response varied with age, with minimal response among infants aged 40 days. Overall, anaesthesia was achieved after at least 25 min and lasted 20-30 min. Maximum anaesthesia was achieved after at least 30 min (except among those aged >45 days where it was not achieved) and lasted up to 10 min. Conclusion The optimal timing for maximum topical anaesthesia occurred before the recommended 60 min of waiting time. A shorter waiting time and speed may be efficient for mass device-based circumcision.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stephen Watya
- Weill Cornell Medicine of Cornell UniversityNew YorkNew YorkUSA
- Urocare HospitalKampalaUganda
| | - Philip S. Li
- Weill Cornell Medicine of Cornell UniversityNew YorkNew YorkUSA
| | - Richard K. Lee
- Weill Cornell Medicine of Cornell UniversityNew YorkNew YorkUSA
| | - Ronald H. Gray
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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25
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Sun Y, He L, Gao Y, Fitzpatrick T, Zhang W, Yang L, Fu L, Luo S, Zou H. Barriers and Facilitators to, and Experience of, Voluntary Medical Male Circumcision Among Men Who Have Sex with Men in China: A Mixed-Methods Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2065-2081. [PMID: 37296334 PMCID: PMC11034941 DOI: 10.1007/s10508-023-02634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023]
Abstract
Voluntary medical male circumcision (VMMC) may be incorporated into HIV prevention services for men who have sex with men (MSM). We conducted a mixed-methods study to elucidate barriers and facilitators to, and experience of, VMMC among MSM. Participants were MSM aged 18 years and older who were enrolled in an ongoing multicenter randomized controlled trial (RCT) to evaluate VMMC to prevent HIV among MSM in China. RCT participants completed a questionnaire before and after VMMC to assess perceptions of and complications after the procedure. A subset of RCT participants were selected for in-depth interviews. Interviewees answered open-ended questions about barriers and facilitators to and experience of undergoing VMMC. Six-step thematic analysis incorporating inductive and deductive approaches was used to interpret interview responses. A total of 457 MSM completed the pre-VMMC survey, 115 circumcised MSM completed post-VMMC surveys, and 30 MSM completed an interview. Main barriers to VMMC uptake were concerns about pain, length of wound healing, cost, lack of knowledge about or misconceptions of VMMC, and stigma related to surgery. Facilitators to VMMC could be categorized as internal factors (foreskin) and external factors (motivation and follow-up care). Interestingly, the VMMC experiences of others could be transformed from a barrier into a facilitator to VMMC in some circumstances. After VMMC participants transitioned from a negative state of pain, remorse, difficulty sleeping, and discomfort to a positive state of symptom alleviation and personal hygiene improvement. Optimizing facilitators and addressing barriers may encourage VMMC among MSM. Joint efforts should be made by relevant stakeholders to improve the awareness and uptake of VMMC among MSM.
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Affiliation(s)
- Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Longtao He
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Luoyao Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 66 Gongchang Road, Guangming District, Shenzhen, 518107, Guangdong, China.
- Kirby Institute, University of New South Wales, Sydney, Australia.
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Palmer E, Marais L, Engelbrecht M. Black Women's Perceptions Towards Infant and Child Male Circumcision. Matern Child Health J 2023:10.1007/s10995-023-03693-6. [PMID: 37273136 DOI: 10.1007/s10995-023-03693-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this article was to analyse women's perceptions of ICMC and to propose a framework for ICMC decision-making that can inform ICMC policies. METHOD Using qualitative interviews, this study investigated twenty-five Black women's perceptions of ICMC decisionmaking in South Africa. Black women who had opted not to circumcise their sons, were selected through purposive and snowball sampling. Underpinned by the Social Norms Theory, their responses were analysed through in-depth interviews and a framework analysis. We conducted the study in the townships of Diepsloot and Diepkloof, Gauteng, South Africa. RESULTS Three major themes emerged: medical mistrust, inaccurate knowledge leading to myths and misconceptions, and cultural practices related to traditional male circumcision. Building Black women's trust in the public health system is important for ICMC decision-making. CONCLUSIONS FOR PRACTICE Policies should address misinformation through platforms that Black women share. There should be an acknowledgement of the role that cultural differences play in the decision-making process. This study developed an ICMC perception framework to inform policy.
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Affiliation(s)
- Eurica Palmer
- Centre for Development Support, Faculty of Economic and Management Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Lochner Marais
- Centre for Development Support, Faculty of Economic and Management Sciences, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Rodriguez VJ, Weiss SM, Hernández L, Bowa K, Zulu R, Jones DL. Zambian Parents' Perspectives on Early-Infant Versus Early-Adolescent Male Circumcision. AIDS Behav 2023; 27:1800-1806. [PMID: 36692607 PMCID: PMC10338018 DOI: 10.1007/s10461-022-03912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 01/25/2023]
Abstract
Despite increasing interest in Early-Infant and Early-Adolescent Medical Circumcision (EIMC and EAMC, respectively) in Zambia, parental willingness to have their sons undergo the procedure has not been explored. This study describes Zambian parents' perspectives on EIMC and EAMC. A total of N = 600 men and women (n = 300 couples) were recruited. Most parents, 89% and 83%, planned to have their newborn or adolescent sons circumcised, respectively, and 70% and 57% had plans for EIMC and EAMC, respectively. Most (91% for infants and 86% for adolescents) reported they were considering the pros and cons of circumcision. Parents' age (OR 1.05), having children living in one's home (OR 3.58), and lower education (OR 0.63) were associated with sons' circumcision. The minimal risks associated with circumcision and the lifetime benefits conferred underscore its contribution to public health in high HIV prevalence areas.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lucila Hernández
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Robert Zulu
- Ministry of Health, Provincial Health Office, Ndola, Copperbelt, Zambia
- Department of Health Promotion and Education, University of Zambia, School of Public Health, Lusaka, Zambia
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Dominion Towers Suite 404, 1400 NW 10Th Avenue, Miami, FL, 33136, USA.
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Ong KS, Laube C, Mohan D, Iverson L, Kaonga A, Chituwo O, Kamboyi R, Kabila M, Toledo C. Factors Beyond Compensation Associated with Uptake of Voluntary Medical Male Circumcision in Zambia. AIDS Behav 2023; 27:1836-1848. [PMID: 36357807 PMCID: PMC10979468 DOI: 10.1007/s10461-022-03915-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
Abstract
Voluntary medical male circumcision (VMMC) provides partial protection against female-to-male transmission of HIV. The Maximizing the Impact of Voluntary Medical Male Circumcision in Zambia (MAXZAM) project was a phased implementation of a demand generation strategy for VMMC through economic compensation. Previously published findings showed increased uptake of VMMC when compensation was provided. This paper is a follow-up evaluation of the MAXZAM project exploring additional factors associated with uptake of VMMC. Factors found associated include the outreach setting in which men were approached, number of information sources seen, heard, or read about VMMC, their self-reported HIV risk behaviors, their self-reported intention to go through the procedure, and their behavioral-psychographic profile. The findings highlight the importance of considering general (e.g., intensifying mass communications and targeting specific settings) and person-centered demand generation approaches (e.g., considering the client's psychographic profile and HIV risk level) to maximize effect on VMMC uptake.
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Affiliation(s)
- Katherine S Ong
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, 1 Corporate Boulevard NE, Atlanta, GA, Mailstop US1-1, USA.
| | | | - Diwakar Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Omega Chituwo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | | | - Carlos Toledo
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, 1 Corporate Boulevard NE, Atlanta, GA, Mailstop US1-1, USA
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29
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Gao Y, Zheng W, Sun Y, Yang L, Guo Z, Li Y, Lin YF, Lu Z, Yuan T, Zhan Y, Qian HZ, Su B, Zhu Z, Duan J, Wang G, Cui X, Ouyang L, Sheng G, Zhou Y, Long A, Yao Y, Fitzpatrick T, Yu M, Wu G, Zou H. Voluntary Medical Male Circumcision and Incident HIV Infection Among Men Who Have Sex With Men in China (The CoM Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47160. [PMID: 37247211 PMCID: PMC10262017 DOI: 10.2196/47160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Systematic reviews and meta-analyses based on observational studies have shown voluntary medical male circumcision (VMMC) may reduce HIV risk among men who have sex with men (MSM). There is a lack of randomized controlled trial (RCT) data assessing the efficacy of VMMC. OBJECTIVE The primary objective of this study was to assess the efficacy of VMMC for preventing HIV acquisition among MSM who primarily engage in insertive anal sex. METHODS A multicenter RCT will be conducted among MSM in 8 cities in China. Eligible participants are men aged 18-49 years who self-report ≥2 male sex partners in the past 6 months, predominantly practice insertive anal sex, and are willing to undergo circumcision. Interested men who satisfy inclusion criteria will be tested for HIV 1 month before enrollment and at enrollment, and only those who are HIV negative will be enrolled. At baseline, all enrolled participants will be asked to report sociodemographic characteristics and sexual behaviors; provide a blood sample for HIV, syphilis, and herpes simplex virus type 2 testing; and provide a penile swab for human papillomavirus testing. Participants will be randomly assigned to the intervention or control group. Those in the intervention group will receive VMMC and undergo a web-based weekly follow-up assessment of postsurgery healing for 6 consecutive weeks. All participants will be tested for HIV at 3-, 6-, 9-, and 12-month follow-ups. All participants will also be asked to report sexual behaviors and undergo repeat herpes simplex virus type 2 and human papillomavirus testing at 6- and 12-month follow-ups. The primary end point is HIV seroconversion. Secondary end points are the safety and satisfaction with VMMC and the changes in sexual behaviors after VMMC. The grouped censored data will be analyzed by intention-to-treat approach. RESULTS Recruitment for the RCT began in August 2020 and continued through July 2022. Data collection is expected to be completed by July 2023, and full data analysis is going to be completed by September 2023. CONCLUSIONS This study will be the first RCT to assess the efficacy of VMMC in preventing HIV infection among MSM. Results from this trial will provide preliminary evidence for the potential efficacy of VMMC to reduce incident HIV infection among MSM. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000039436; https://www.chictr.org.cn/showproj.html?proj=63369. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47160.
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Affiliation(s)
- Yanxiao Gao
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Weiran Zheng
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yinghui Sun
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Luoyao Yang
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Zhihui Guo
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yuwei Li
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yi-Fan Lin
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Tanwei Yuan
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Yuewei Zhan
- School of Public Health, Sun Yat-sen University, Shenzhen, China
| | - Han-Zhu Qian
- GlaxoSmithKline plc, Rockville, MD, United States
| | - Bin Su
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhiqiang Zhu
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Junyi Duan
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China
| | - Xin Cui
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, China
| | - Lin Ouyang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Genshen Sheng
- Shenzhen Rainbow 258 Centre for Men, Shenzhen, China
| | - Yepeng Zhou
- Foshan Pengyou Care and Rescue Center for AIDS Prevention, Foshan, China
| | - Ao Long
- Luzhou Red Ribbon Heart Association, Luzhou, China
| | - Yuming Yao
- Zhitong LGBT Service Center, Guangzhou, China
| | - Thomas Fitzpatrick
- Department of Internal Medicine, University of Washington, Seattle, WA, United States
| | - Maohe Yu
- Tianjin Municipal Center for Disease Control and Prevention, Tianjin, China
| | - Guohui Wu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Huachun Zou
- School of Public Health, Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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30
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Asa GA, Fauk NK, Ward PR. Traditional male circumcision and the risk for HIV transmission among men: a systematic review. BMJ Open 2023; 13:e072118. [PMID: 37208134 DOI: 10.1136/bmjopen-2023-072118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES To synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on the initiates, their families and societies. DESIGN Systematic review. DATA SOURCE PubMed, CINHAL, SCOPUS, ProQuest, Cochrane database and Medline were searched between 15 and 30 October 2022. ELIGIBILITY CRITERIA (1) Studies involving young men, young male adults, male adults and mixed male and female participants; (2) studies on TMC involving men living with HIV (married and non-married); (3) studies on TMC, HIV transmission and impact in low-income and middle-income countries; (4) qualitative, quantitative and mixed-method studies and (5) studies aimed at exploring TMC and how it contributes to HIV transmission and the impacts of HIV on circumcised men and their families. DATA EXTRACTION Data were extracted based on study details, study design, characteristics of participants and results. RESULT A total of 18 studies were included: 11 were qualitative studies, five were quantitative studies and two were mixed-method studies. All the studies included were conducted in areas where TMC was performed (17 in Africa and one in Papua New Guinea). The review's findings were categorised into themes: TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families and TMC-related risk of HIV transmission. CONCLUSION This systematic review highlights that TMC practice and HIV risk could negatively impact men and their families. Existing evidence suggests that little attention has been paid to men and their families experiencing the impacts of TMC and HIV risk factors. The findings recommend the need for health intervention programmes such as safe circumcision and safe sexual behaviours following TMC and efforts to address psychological and social challenges in communities practising TMC. PROSPERO REGISTRATION NUMBER CRD42022357788.
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Affiliation(s)
- Gregorius Abanit Asa
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
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Santiago-Rodriguez TM, Le François B, Macklaim JM, Doukhanine E, Hollister EB. The Skin Microbiome: Current Techniques, Challenges, and Future Directions. Microorganisms 2023; 11:1222. [PMID: 37317196 PMCID: PMC10223452 DOI: 10.3390/microorganisms11051222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
Skin acts as a barrier that promotes the colonization of bacteria, fungi, archaea, and viruses whose membership and function may differ depending on the various specialized niches or micro-environments of the skin. The group of microorganisms inhabiting the skin, also known as the skin microbiome, offers protection against pathogens while actively interacting with the host's immune system. Some members of the skin microbiome can also act as opportunistic pathogens. The skin microbiome is influenced by factors such as skin site, birth mode, genetics, environment, skin products, and skin conditions. The association(s) of the skin microbiome with health and disease has (have) been identified and characterized via culture-dependent and culture-independent methods. Culture-independent methods (such as high-throughput sequencing), in particular, have expanded our understanding of the skin microbiome's role in maintaining health or promoting disease. However, the intrinsic challenges associated with the low microbial biomass and high host content of skin microbiome samples have hindered advancements in the field. In addition, the limitations of current collection and extraction methods and biases derived from sample preparation and analysis have significantly influenced the results and conclusions of many skin microbiome studies. Therefore, the present review discusses the technical challenges associated with the collection and processing of skin microbiome samples, the advantages and disadvantages of current sequencing approaches, and potential future areas of focus for the field.
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32
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Jindai K, Farley T, Awori Q, Temu AS, Ndenzako F, Samuelson J. Systematic review: Safety of surgical male circumcision in context of HIV prevention public health programmes. Gates Open Res 2023; 6:164. [PMID: 37089877 PMCID: PMC10115943 DOI: 10.12688/gatesopenres.13730.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background: Since the recommendation of voluntary medical male circumcision (VMMC) to reduce the risk of heterosexually acquired HIV, a number of adolescent boys and men in 15 priority countries in Africa have been circumcised. Our primary goal was to identify the incidence of adverse events (AEs) associated with VMMC and to assess the safety profile among adolescent boys 10 - 14 years. Methods: We searched the databases MEDLINE and Embase, WHO, and conference abstracts from 2005 to 2019. The incidence of AEs was estimated by type of AE, size of study and age. Results: We retained 40 studies. Severe and moderate AEs overall were estimated at 0.30 per 100 VMMC clients with wide variability per study type. A higher rate was noted in small and moderate scale programmes and device method research studies compared with larger scale programmes. There was a limited number of studies reporting AEs among younger adolescent boys and they had higher infection-related AEs than those aged 20 years and older. Case studies noted rare AEs such as necrotizing fasciitis, tetanus, and glans injury. Conclusions: AE rates were comparable to those from the randomized controlled trials (RCTs) that led to recommendations and implementation of VMMC in high HIV burden countries, despite being implemented in low resource settings. Clients over time have increasingly included adolescents under the age of 15 years. Studies suggest potentially higher risks in this age group. As VMMC services are sustained, patient safety surveillance systems and promoting a patient safety culture are crucial to identify and mitigate potential harms from medical male circumcision.
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Affiliation(s)
- Kazuaki Jindai
- Department of Virology, Tohoku University, Sendai, Japan
- Department of Healthcare Epidemiology, Kyoto University, Kyoto, Japan
| | | | | | | | - Fabian Ndenzako
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Linfield RY, Wendling R, Slusky DJG. The 1982 Medicaid Funding Cessation for Circumcision in California and Circumcision Rates. AIDS Behav 2023; 27:1647-1652. [PMID: 36344730 DOI: 10.1007/s10461-022-03896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
We investigated California's 1982 decision to stop funding Medicaid neonatal circumcision. We examined male neonatal circumcision rates for those born 1977-1981 and 1983-1987 by region, race, and insurance status. Overall, West-Medicaid circumcision rates decreased from 56.5% in 1979-81 to 26.7% in 1983-85. California's 1982 decision to defund Medicaid circumcision coverage was associated with a 25.0-30.8% point decrease in West-Medicaid circumcision rates compared other groups, p < 0.01. This provides the earliest data to support that funding coverage for neonatal circumcision affects circumcision rates and magnifies healthcare disparities. Other states have since defunded Medicaid male neonatal circumcision. Circumcision have been associated with lower rates of sexually transmitted infections including HIV, and urinary tract infections. Lawmakers should consider re-funding Medicaid male neonatal circumcision.
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Affiliation(s)
- Rebecca Y Linfield
- Division of Infectious Diseases, Stanford University, Palo Alto, CA, USA
| | - Ryan Wendling
- Department of Economics, University of Kansas, 1460 Jayhawk Blvd, Snow Hall 415, 66045, Lawrence, KS, USA
| | - David J G Slusky
- Department of Economics, University of Kansas, 1460 Jayhawk Blvd, Snow Hall 415, 66045, Lawrence, KS, USA.
- IZA - Institute of Labor Economics, Bonn, Germany.
- National Bureau of Economic Research, Cambridge, MA, USA.
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Luseno WK, Rennie S, Gilbertson A. A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa. Int J Impot Res 2023; 35:269-278. [PMID: 34702986 PMCID: PMC8545773 DOI: 10.1038/s41443-021-00484-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022]
Abstract
Ideally, the benefits of public health interventions should outweigh any associated harms, burdens, and adverse unintended consequences. The intended benefit of voluntary medical male circumcision (VMMC) programs in eastern and southern Africa (ESA) is the reduction of HIV infections. We review the literature for evidence of reductions in HIV incidence, evaluate the extent to which decreases in HIV incidence can be reasonably attributed to VMMC programs, and summarize social harms and ethical concerns associated with these programs. Review findings suggest that HIV incidence had been declining across ESA since before the large-scale rollout of VMMC as a public health intervention, and that this decline may be due to the combined effects of HIV prevention and treatment interventions, such as expanded antiretroviral therapy. The independent effect of VMMC programs in reducing HIV infections at the population level remains unknown. On the other hand, VMMC-associated evidence is increasing for the existence of negative social impacts such as stigmatization and/or discrimination, and ethically problematic practices, including lack of informed consent. We conclude that the relationship between the benefits and burdens of VMMC programs may be more unfavorable than what has been commonly suggested by proponents of global VMMC campaigns.
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Affiliation(s)
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
- UNC Center for Bioethics, University of North Carolina, Chapel Hill, NC, USA
| | - Adam Gilbertson
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, NC, USA
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Perkins JM, Kakuhikire B, Baguma C, Jeon S, Walker SF, Dongre R, Kyokunda V, Juliet M, Satinsky EN, Comfort AB, Siedner M, Ashaba S, Tsai AC. Perceived norms about male circumcision and personal circumcision status: a cross-sectional, population-based study in rural Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.24.23288996. [PMID: 37163008 PMCID: PMC10168507 DOI: 10.1101/2023.04.24.23288996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Introduction Over the past decade, 15 high-priority countries in eastern and southern Africa have promoted voluntary medical male circucmsion for HIV and STI prevention. Despite male circumcision prevalence in Uganda nearly doubling from 26% in 2011 to 43% in 2016, it remained below the target level by 2020. Little is known about perceived norms of male circumcision and their association with circumcision uptake among men. Methods We conducted a cross-sectional study targeting all adult residents across eight villages in Rwampara District, southwestern Uganda in 2020-2022. We compared what men and women reported as the adult male circumcision prevalence within their village (perceived norm: >50% (most), 10% to <50% (some), <10%, (few), or do not know) to the aggregated prevalence of circumcision as reported by men aged <50 years. We used a modified multivariable Poisson regression model to estimate the association between perceived norms about male circumcision uptake and personal circumcision status among men. Results Overall, 167 (38%) men < 50 years old were circumcised (and 27% of all men were circumcised). Among all 1566 participants (91% response rate), 189 (27%) men and 177 (20%) women underestimated the male circumcision prevalence, thinking that few men in their own village had been circumcised. Additionally, 10% of men and 25% of women reported not knowing the prevalence. Men who underestimated the prevalence were less likely to be circumcised (aRR = 0.51, 95% CI 0.37 to 0.83) compared to those who thought that some village men were circumcised, adjusting for perceived personal risk of HIV, whether any same-household women thought most men were circumcised, and other sociodemographic factors. Conclusions Across eight villages, a quarter of the population underestimated the local prevalence of male circumcision. Men who underestimated circumcision uptake were less likely to be circumcised. Future research should evaluate norms-based approaches to promoting male circumcision uptake. Strategies may include disseminating messages about the increasing prevalence of adult male circumcision uptake in Uganda and providing personalized normative feedback to men who underestimated local rates about how uptake is greater than they thought.
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Affiliation(s)
- Jessica M. Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sehee Jeon
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Sarah F. Walker
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Rohit Dongre
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Alison B. Comfort
- Bixby Center for Global Reproductive Health, University of California, San Franciso, USA
| | - Mark Siedner
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston MA USA
| | | | - Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston MA USA
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Zheng Z, Ding K, Tang Z, Wu Z, Li Z, Wang G, Fan B, Wang Z. Anesthesia Analysis of Compound Lidocaine Cream Alone in Adult Male Device-Assisted Circumcision. J Clin Med 2023; 12:jcm12093121. [PMID: 37176562 PMCID: PMC10179153 DOI: 10.3390/jcm12093121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE to evaluate the anesthetic effect among adult male patients with the single use of compound lidocaine cream in device-assisted circumcision, hoping to provide an anesthetic method for the simplification of the surgical process. METHODS Male adult patients undergoing device-assisted circumcision through prepuce local anesthesia using lidocaine cream in Xiangya Hospital of Central South University from December 2020 to August 2021 were selected. According to different age groups and different surgical procedures, the anesthetic effect of compound lidocaine cream was analyzed considering the aspects of anesthetic cost, anesthetic time, anesthetic duration, anesthetic effect, anesthetic side effects and anesthetic satisfaction. RESULTS In the study, 99.1% of 649 patients needed only 1 application of compound lidocaine cream to complete the operation. The time taken for anesthesia was short; the whole anesthesia process only required approximately 2-5 min. However, for patients with severe phimosis, the time to complete the anesthesia procedure was correspondingly longer. The pain degree caused by anesthesia was low, and the patients with a pain score of ≤3 points accounted for 96.7%. The anesthetic effect lasted for a sufficiently long period, and the time of algesia recovery from local anesthesia was almost 1 h after surgery. The anesthesia effect was sufficient, and patients with an intraoperative pain score of ≤3 accounted for 98.7%, which could meet the surgical requirements. There were few side effects of the anesthesia. The overwhelming majority of patients were pleased with the anesthesia, and 98.9% of patients had an anesthesia satisfaction score of ≥7. CONCLUSION The compound lidocaine cream, as a local anesthetic, is safe and effective for most adult male device-assisted circumcisions. More useful information needs to be corroborated by more advanced evidence, especially for severe phimosis.
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Affiliation(s)
- Zhihuan Zheng
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ke Ding
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha 410008, China
| | - Ziqiang Wu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhongyi Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guilin Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Benyi Fan
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhao Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
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Laher F, Otwombe K, Mokwena O, Bekker LG, Allen M. Use of Varied Screening Risk Criteria and HIV Incidence in Phase 1 and 2 HIV Vaccine Trials in South Africa. AIDS Behav 2023; 27:1314-1320. [PMID: 36287343 PMCID: PMC10038814 DOI: 10.1007/s10461-022-03867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/01/2022]
Abstract
Many early phase HIV prevention studies define HIV risk-related eligibility criteria. We conducted a retrospective review of HIV Vaccine Trials Network (HVTN) Phase 1 and 2 HIV vaccine clinical trials completed in South Africa from 2003 to 2020, evaluating HIV incidence by protocol-defined risk criteria. Comparisons between groups controlled for age, gender and year of trial initiation. Across 12 trials, 1 did not specify risk criteria, and 11 specified various low risk criteria thematically categorized under sexual behaviors, clinical characteristics, and/or drug use behavior. Of the 11 trials, 6 used low sexual risk eligibility criteria standardized by the HVTN in 2009. Of the 1249 participants, median age 23.0 years, 66% were enrolled with the HVTN 2009 standardized low risk criteria, 15% using other sets of low risk criteria, and 19% using no risk criteria. Compared with the standardized low risk criteria group [2.3], HIV incidence per 100 person-years was significantly higher in the non-standardized low risk criteria group [5.0] and in the no risk criteria group [4.8]. In South Africa, cohorts with low HIV incidence can be identified primarily through sexual behavior and clinical characteristics.
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Affiliation(s)
- Fatima Laher
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa.
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ofentse Mokwena
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mary Allen
- Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Zewdie K, Pickles M, Floyd S, Fidler S, Ayles H, Bock P, Hoddinott G, Mandla N, Shanaube K, Simwinga M, Fraser C, Seeley J, Piwowar-Manning E, Hayes R, Donnell D. Uptake of medical male circumcision with household-based testing, and the association of traditional male circumcision and HIV infection. AIDS 2023; 37:795-802. [PMID: 36727597 PMCID: PMC10023451 DOI: 10.1097/qad.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Voluntary medical male circumcision (VMMC) is an important component of combination HIV prevention. Inclusion of traditionally circumcised HIV negative men in VMMC uptake campaigns may be important if traditional male circumcision is less protective against HIV acquisition than VMMC. METHODS We used data from the HIV Prevention Trials Network (HPTN) 071 (PopART) study. This cluster-randomized trial assessed the impact of a combination prevention package on population-level HIV incidence in 21 study communities in Zambia and South Africa. We evaluated uptake of VMMC, using a two-stage analysis approach and used discrete-time survival analysis to evaluate the association between the types of male circumcision and HIV incidence. RESULTS A total of 10 803 HIV-negative men with self-reported circumcision status were included in this study. At baseline, 56% reported being uncircumcised, 26% traditionally circumcised and 18% were medically circumcised. During the PopART intervention, 11% of uncircumcised men reported uptake of medical male circumcision. We found no significant difference in the uptake of VMMC in communities receiving the PopART intervention package and standard of care {adj. rate ratio=1·10 [95% confidence interval (CI) 0.82, 1.50, P = 0.48]}. The rate of HIV acquisition for medically circumcised men was 70% lower than for those who were uncircumcised adjusted hazard ratio (adjHR) = 0.30 (95% CI 0.16-0.55; P < 0.0001). There was no difference in rate of HIV acquisition for traditionally circumcised men compared to those uncircumcised adjHR = 0.84 (95% CI 0.54, 1.31; P = 0.45). CONCLUSIONS Household-based delivery of HIV testing followed by referral for medical male circumcision did not result in substantial VMMC uptake. Traditional circumcision is not associated with lower risk of HIV acquisition.
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Affiliation(s)
- Kidist Zewdie
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Helen Ayles
- ZAMBART, University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nomtha Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kwame Shanaube
- ZAMBART, University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - Musonda Simwinga
- ZAMBART, University of Zambia, School of Medicine, Ridgeway Campus, Lusaka, Zambia
| | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Mphepo KYG, Muula AS, Suzi J, Phuka F, Mfutso-Bengo J. Exploring culturally-preferred communication approaches for increased uptake of voluntary medical male circumcision (VMMC) services in rural Malawi. BMC Public Health 2023; 23:590. [PMID: 36991391 PMCID: PMC10061708 DOI: 10.1186/s12889-023-15363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/02/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In 2007 WHO and UNAIDS recommended communication interventions as a key strategy for creating demand for Voluntary Medical Male Circumcision (VMMC) in Southern Africa. In Malawi, VMMC communication interventions, implemented by health communication agencies, have effectively raised awareness of services. However, high awareness of VMMC has not resulted in increased uptake. Consequently, Malawi has achieved the lowest number of circumcisions in Southern Africa. METHODS These researchers carried out a study among the traditionally circumcising Yaos of Mangochi in Southern Region and the non-circumcising Chewas in Central Region. Data were collected using FGDs, KIIs, IDIs, Life Histories and Participatory Rural Appraisal methods. Data were analyzed thematically. RESULTS This study demonstrates two lessons. First, Laswell's Theory, which has traditionally been used in politics, is relevant to the health sector where the message delivery continuum also needs to be clear on source, message, audience, channel and intended effects. Secondly, according to informants, allowing communities to give feedback to the VMMC messages delivered by health promoters is fundamental. Therefore, failure by Laswell Theory to emphasize on feedback compromises its efficacy. It weakens its ability to foster a common vision between the source and the audience which is prerequisite for behavioral change. CONCLUSION The study concluded that community engagement and interpersonal communication which provide room for real-time feedback in any communicative event are the most preferred communication interventions for VMMC services among Yaos and Chewas.
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Affiliation(s)
- Kent Yelemia G Mphepo
- Department of Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi.
| | - Adamson Sinjani Muula
- Department of Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Joel Suzi
- Department of Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Felix Phuka
- Department of Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- Department of Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
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Chen X, Lai Y. Knowledge domain and emerging trends in HIV pre-exposure prophylaxis: A visualization analysis via CiteSpace. Front Microbiol 2023; 14:1099132. [PMID: 37007528 PMCID: PMC10060873 DOI: 10.3389/fmicb.2023.1099132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundAs an effective strategy that reduces transmission among people at high risk of human immunodeficiency virus (HIV), pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention. Our study aims to provide a reference for the development of relevant research and the formulation of prevention and control policies for HIV.MethodsThrough CiteSpace software, this study aims to present a comprehensive overview of the HIV PrEP knowledge structure, hotspots, and frontiers. We searched the Web of Science Core Collection for studies published between 2012 and 2022 related to HIV PrEP, and 3,243 papers remained after selection.ResultsThe number of HIV PrEP publications has increased over the past few years. A close integration and exchange of HIV PrEP research findings has taken place between countries and authors. Major ongoing research trends include long-term injection PrEP, the impact of chlamydia on HIV PrEP, and individual awareness of and attitudes toward HIV PrEP. Thus, more attention should be paid to innovations and breakthroughs in drugs, the factors that affect HIV transmission and susceptibility, and the future promotion of public acceptance of HIV PrEP.ConclusionThis study offers a systematic, objective, and comprehensive analysis of the related articles. It will assist scholars in understanding the dynamic evolution of HIV PrEP research and identifying future research areas to better advance the development of the field.
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Zaliznyak M, Isaacson D, Duralde E, Gaither TW, Naser-Tavakolian A, Bresee C, Stelmar J, Yuan N, Topp K, Garcia MM. Anatomic maps of erogenous sensation and pleasure in the penis: are there difference between circumcised and uncircumcised men? J Sex Med 2023; 20:253-259. [PMID: 36763960 DOI: 10.1093/jsxmed/qdac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The effects of male circumcision on sexual function remain controversial. Heterogeneity across previous studies and low-quality scientific evidence have resulted in poor understanding of the effects of circumcision on erogenous sensation of the penis and orgasm function. AIM In this study we sought to describe and assess differences in erogenous genital sensation and reported orgasm function in circumcised compared with uncircumcised men. METHODS Adult male subjects who were recruited on a paid anonymous online survey platform were shown illustrations of 12 anatomic regions of the penis. Subjects were prompted to designate regions as pleasurable when touched during partnered sex and to rate each on a 1-10 scale, with higher erogeneity scores correlating with greater pleasure. Subjects were also asked to characterize their orgasms across 6 experiential domains. OUTCOMES Outcomes were differences between circumcised and uncircumcised men in the probabilities that regions would be designated as pleasurable, average pleasure scores, and self-reported orgasm parameters. RESULTS In total, 227 circumcised (mean [SD] age 46.6 [17.7] years) and 175 uncircumcised men (47.8 [18.1] years) completed the survey. There were no significant differences in average ratings across all regions between circumcised and uncircumcised men. However, significantly more circumcised men reported preferences for the tip of the penis (38% vs 17%, P = .02) and the middle third of the ventral penile shaft (63% vs 48%, P = .04). Additionally, there were no significant differences in orgasm quality and function across all queried domains between circumcised and uncircumcised cohorts. CLINICAL IMPLICATIONS Our findings suggest that circumcision does not change how men describe erogenous genital sensation or how they experience orgasm. STRENGTHS AND LIMITATIONS In this study we expanded upon existing literature regarding comparison of sexual function in circumcised and uncircumcised men in its scale and investigation of diverse domains. Limitations include the survey format of data collection. CONCLUSION We found no differences in reported erogenous ratings or orgasm function between circumcised and uncircumcised men. These findings suggest that male circumcision does not negatively impact penile erogeneity or orgasm function.
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Affiliation(s)
- Michael Zaliznyak
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Dylan Isaacson
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Erin Duralde
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Catherine Bresee
- Biostatistics & Bioinformatics Core, Cedars-Sinai Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, United States
| | - Jenna Stelmar
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Nance Yuan
- Nance Yuan, MD Plastic Surgery, Los Angeles, CA, United States
| | - Kimberly Topp
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, United States
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Cedars-Sinai Transgender Surgery and Health Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.,Department of Urology and Anatomy, University of California San Francisco, San Francisco, CA, United States
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Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study. BMC Public Health 2023; 23:349. [PMID: 36797696 PMCID: PMC9933013 DOI: 10.1186/s12889-023-15228-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND In countries such as Eswatini, where there is a high HIV prevalence and low male circumcision the World Health Organization and the Joint United Nations Programme for HIV/AIDS recommend infant and adult circumcision be implemented. The aim of this study was to assess the knowledge, attitudes and acceptability of voluntary medical male circumcision amongst males attending high school in Eswatini. METHODS An observational cross-sectional study was conducted during February and March of 2018 amongst 407 young males (15-21 years) attending Form 4, in nine high schools in the Shiselweni region of Eswatini using a self-administered questionnaire of 42 close ended questions. Sociodemographic details, circumcision status, acceptance of voluntary medical male circumcision, knowledge and attitude scores analysed in Stata® 14 statistical software were described using frequencies, medians and ranges respectively. Bivariate and multivariate linear regression was used to assess the impact of independent variables on circumcision status and acceptance of voluntary medical male circumcision. The level of statistical significance was p < 0.05. RESULTS Amongst the 407 high school-going males, 48.98% (n = 201) reported being circumcised. The majority of the adolescents (75.74%; n = 306) were knowledgeable about voluntary medical male circumcision. However, an even larger majority (84.90% (n = 343) had a negative attitude towards it. In the multivariate logistic regression analysis, having parented their own children (aOR: 3.55; 95%CI: 1.2-10.48), and having circumcised friends (aOR: 3.99; 95%CI: 1.81-8.84) were significantly associated with being circumcised. Neither knowledge nor attitude were associated with the acceptability of voluntary medical male circumcision. CONCLUSION In Eswatini male high school students are knowledgeable about voluntary medical male circumcision but have a negative attitude towards it. Having parented their own children, and having circumcised friends influenced being circumcised.
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Grund JM, Onchiri F, Mboya E, Ussery F, Musingila P, Ohaga S, Odoyo-June E, Bock N, Ayieko B, Agot K. Strategies to increase uptake of voluntary medical male circumcision among men aged 25-39 years in Nyanza Region, Kenya: Results from a cluster randomized controlled trial (the TASCO study). PLoS One 2023; 18:e0276593. [PMID: 36735665 PMCID: PMC9897540 DOI: 10.1371/journal.pone.0276593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/04/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Voluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region. MATERIALS AND METHODS We conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome. RESULTS At baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67. DISCUSSION Using these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02497989.
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Affiliation(s)
- Jonathan M. Grund
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Frankline Onchiri
- Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Edward Mboya
- Impact Research and Development Organization, Kisumu, Kenya
| | - Faith Ussery
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Paul Musingila
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Naomi Bock
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benard Ayieko
- Impact Research and Development Organization, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
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Waltmann A, Thomas C, Duncan JA. The role of the genital microbiota in the acquisition and pathogenesis of sexually transmitted infections. Curr Opin Infect Dis 2023; 36:35-48. [PMID: 36729748 PMCID: PMC10500551 DOI: 10.1097/qco.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW There are an estimated 374 million new sexually transmitted infections (STIs) worldwide every year. Our review article examines the current evidence of how STI acquisition, transmission, and pathogenesis is impacted upon by the genital microbiota, with a focus on epidemiological, biochemical, and immunological features. RECENT FINDINGS At least in women, a genital microbiota dominated by lactobacilli has long been considered optimal for reproductive health, while depletion of lactobacilli may lead to a genital microenvironment dominated by anaerobic pathogens, which can manifest clinically as bacterial vaginosis. Recent research efforts have characterized genital microbiota composition in greater resolution, sometimes at species-level, using proteomics, metabolomics, and deep sequencing. This has enhanced our understanding of how specific microbiota members influence acquisition or clinical manifestation of STI pathogen infection. Other advances include a steady, though still slow, increase in the number of studies that sought to determine the genital (penile or urethral) microbiota of males and how it may impact that of their female partners' genital microbiota and risk of STI acquisition. Altogether, these data enabled us to explore the concept that genital microbiota may be sexually transmitted and influence pathogenesis and clinical presentation of other STI. SUMMARY With STI infection rates increasing worldwide, it is important now more than ever to find novel STI prevention strategies. Understanding if and how the genital microbiota is a modifiable risk factor for STI transmission, acquisition, and clinical manifestation may prove to be an important strategy in our efforts to curb morbidity in at risk populations.
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Affiliation(s)
- Andreea Waltmann
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cynthia Thomas
- Graduate Program, Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Pharmacology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Bansi-Matharu L, Mudimu E, Martin-Hughes R, Hamilton M, Johnson L, Ten Brink D, Stover J, Meyer-Rath G, Kelly SL, Jamieson L, Cambiano V, Jahn A, Cowan FM, Mangenah C, Mavhu W, Chidarikire T, Toledo C, Revill P, Sundaram M, Hatzold K, Yansaneh A, Apollo T, Kalua T, Mugurungi O, Kiggundu V, Zhang S, Nyirenda R, Phillips A, Kripke K, Bershteyn A. Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models. Lancet Glob Health 2023; 11:e244-e255. [PMID: 36563699 PMCID: PMC10005968 DOI: 10.1016/s2214-109x(22)00515-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/11/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Voluntary medical male circumcision (VMMC) has been a recommended HIV prevention strategy in sub-Saharan Africa since 2007, particularly in countries with high HIV prevalence. However, given the scale-up of antiretroviral therapy programmes, it is not clear whether VMMC still represents a cost-effective use of scarce HIV programme resources. METHODS Using five existing well described HIV mathematical models, we compared continuation of VMMC for 5 years in men aged 15 years and older to no further VMMC in South Africa, Malawi, and Zimbabwe and across a range of setting scenarios in sub-Saharan Africa. Outputs were based on a 50-year time horizon, VMMC cost was assumed to be US$90, and a cost-effectiveness threshold of US$500 was used. FINDINGS In South Africa and Malawi, the continuation of VMMC for 5 years resulted in cost savings and health benefits (infections and disability-adjusted life-years averted) according to all models. Of the two models modelling Zimbabwe, the continuation of VMMC for 5 years resulted in cost savings and health benefits by one model but was not as cost-effective according to the other model. Continuation of VMMC was cost-effective in 68% of setting scenarios across sub-Saharan Africa. VMMC was more likely to be cost-effective in modelled settings with higher HIV incidence; VMMC was cost-effective in 62% of settings with HIV incidence of less than 0·1 per 100 person-years in men aged 15-49 years, increasing to 95% with HIV incidence greater than 1·0 per 100 person-years. INTERPRETATION VMMC remains a cost-effective, often cost-saving, prevention intervention in sub-Saharan Africa for at least the next 5 years. FUNDING Bill & Melinda Gates Foundation for the HIV Modelling Consortium.
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Affiliation(s)
| | - Edinah Mudimu
- Department of Decision Sciences, University of South Africa, Pretoria, South Africa
| | | | | | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | | | | | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andreas Jahn
- Ministry of Health, Lilongwe, Malawi; International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Frances M Cowan
- Center for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Collin Mangenah
- Center for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Webster Mavhu
- Center for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Carlos Toledo
- Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Revill
- Centre for Health Economics, University of York, York, UK
| | - Maaya Sundaram
- Global Development Program, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Karin Hatzold
- Population Services International, Washington, DC, USA
| | - Aisha Yansaneh
- United States Agency for International Development, Washington, DC, USA
| | - Tsitsi Apollo
- Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Thoko Kalua
- Department of HIV and AIDS, Ministry of Health Malawi, Lilongwe, Malawi; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Valerian Kiggundu
- United States Agency for International Development, Washington, DC, USA
| | - Shufang Zhang
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health Malawi, Lilongwe, Malawi
| | | | | | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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HIV/AIDS Global Epidemic. Infect Dis (Lond) 2023. [DOI: 10.1007/978-1-0716-2463-0_522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Jaradeh K, Van Fleet Kingery T, Cheruiyot J, Odhiambo F, Bukusi EA, Cohen CR, Shade SB. Cost comparison of a rapid results initiative against standard clinic-based model to scale-up voluntary medical male circumcision in Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000817. [PMID: 36989245 PMCID: PMC10057778 DOI: 10.1371/journal.pgph.0000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023]
Abstract
Voluntary male medical circumcision (VMMC) reduces HIV acquisition by up to 60%. Kenya has successfully scaled up VMMC to an estimated 91% of eligible men and boys in certain regions in combination due to VMMC and cultural circumcisions. VMMC as a program is implemented regionally in traditionally non-circumcising counties where the prevalence is still below 91%, ranging from 56.4% to 66.7%. Given that funding toward VMMC is expected to decline in the coming years, it is important to identify what models of service delivery are most appropriate and efficient to sustainably meet the VMMC needs of new cohorts' eligible men. To this end, we compared the costs of facility-based VMMC and one within a rapid results initiative (RRI), a public health service scheduled during school holidays to perform many procedures over a short period. We employed activity-based micro-costing to estimate the costs, from the implementer perspective, of facility-based VMMC and RRI-based VMMC conducted between October 2017 and September 2018 at 41 sites in Kisumu County, Kenya supported by the Family AIDS care & Education Services (FACES). We conducted site visits and reviewed financial ledger and programmatic data to identify and quantify resources consumed and the number of VMMC procedures performed during routine care and RRIs. Ledger data were used to estimate fixed costs, recurring costs, and cost per circumcision (CPC) in United States dollar (USD). A sensitivity analysis was done to estimate CPC where we allocated 6 months of the ledger to facility-based and 6 months to RRI. Overall, FACES spent $3,092,891 toward VMMC services and performed 42,139 procedures during the funding year. This included $2,644,910 in stable programmatic costs, $139,786 procedure costs, and $308,195 for RRI-specific activities. Over the year, 49% (n = 20,625) of procedures were performed as part of routine care and 51% (n = 21,514) were performed during the RRIs. Procedures conducted during facility-based cost $99.35 per circumcision, those conducted during the RRIs cost $48.51 per circumcision, and according to our sensitivity analysis, CPC for facility-based ranges from $99.35 to $287.24 and for RRI costs ranged from $29.81 to $48.51. The cost of VMMC during the RRI was substantially lower than unit costs reported in previous costing studies. We conclude that circumcision campaigns, such as the RRI, offer an efficient and sustainable approach to VMMC.
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Affiliation(s)
- Katrin Jaradeh
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Tyler Van Fleet Kingery
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Jackline Cheruiyot
- Centre for Microbiology Research, Kenya Medical Research Institute, Nyakach, Kenya
| | - Francesca Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nyakach, Kenya
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Starley B Shade
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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Rudrum S. Circumcision as conquest: Masculinity in Eswatini's voluntary medical male circumcision campaign materials. Glob Public Health 2023; 18:2208202. [PMID: 37156227 DOI: 10.1080/17441692.2023.2208202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
As a public health intervention related to sexual transmission and involving genital surgery, male circumcision for HIV prevention necessarily relates to understandings of sexuality and gender, a relationship which public health campaign materials have shaped in varying ways. Here, I employ discourse analysis to examine messages about gender and sexuality in Eswatini's Soka Uncobe (Circumcise and Conquer) public health campaign for voluntary medical male circumcision (VMMC). The slogan 'conquest' echoes nationalist imagery and extends throughout campaign materials, such as in a comic book presenting the circumcising man as a hero vanquishing an enemy. Elsewhere, campaign materials use the slogan to link sexual conquest to the conquest of HIV in a move that is misleading and potentially harmful. As with several circumcision campaigns in the region, messages about the HIV protection offered through the intervention and the limits to this protection are minimal and are overshadowed by a framing of circumcision as a newly necessary norm for appropriate masculine citizenship and sexuality. This consideration of the positioning of gender, sexuality, and sex in campaign materials promoting VMMC is pertinent to the global public health effort to reduce HIV transmission, particularly given the social complexities at stake in the context of sexual transmission.
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Jindai K, Farley T, Awori Q, Temu AS, Ndenzako F, Samuelson J. Systematic review: Safety of surgical male circumcision in context of HIV prevention public health programmes. Gates Open Res 2022; 6:164. [PMID: 37089877 PMCID: PMC10115943 DOI: 10.12688/gatesopenres.13730.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Since the recommendation of voluntary medical male circumcision (VMMC) to reduce the risk of heterosexually acquired HIV, a number of adolescent boys and men in 15 priority countries in Africa have been circumcised. Our primary goal was to identify the incidence of adverse events (AEs) associated with VMMC and to assess the safety profile among adolescent boys 10 - 14 years. Methods: We searched the databases MEDLINE and Embase, WHO, and conference abstracts from 2005 to 2019. The incidence of AEs was estimated by type of AE, size of study and age. Results: We retained 40 studies. Severe and moderate AEs overall were estimated at 0.30 per 100 VMMC clients with wide variability per study type. A higher rate was noted in small and moderate scale programmes and device method research studies compared with larger scale programmes. There was a limited number of studies reporting AEs among younger adolescent boys and they had higher infection-related AEs than those aged 20 years and older. Case studies noted rare AEs such as necrotizing fasciitis, tetanus, and glans injury. Conclusions: AE rates were comparable to those from the randomized controlled trials (RCTs) that led to recommendations and implementation of VMMC in high HIV burden countries, despite being implemented in low resource settings. Clients over time have increasingly included adolescents under the age of 15 years. Studies suggest potentially higher risks in this age group. As VMMC services are sustained, patient safety surveillance systems and promoting a patient safety culture are crucial to identify and mitigate potential harms from medical male circumcision.
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Affiliation(s)
- Kazuaki Jindai
- Department of Virology, Tohoku University, Sendai, Japan
- Department of Healthcare Epidemiology, Kyoto University, Kyoto, Japan
| | | | | | | | - Fabian Ndenzako
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Bendera A, Nakamura K, Seino K, Al-Sobaihi S. Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling. HIV AIDS (Auckl) 2022; 14:565-575. [PMID: 36571074 PMCID: PMC9785118 DOI: 10.2147/hiv.s387380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) remains the leading cause of years of life lost among adolescent boys in eastern and southern Africa. Medical male circumcision (MMC) is a cost-effective one-time intervention that can reduce the risk of heterosexual HIV acquisition in men by approximately 60%. Despite its importance in HIV prevention, the uptake of MMC remains suboptimal among adolescent boys. This study aimed to identify factors associated with low MMC uptake among adolescent boys in Tanzania. Methods This study was a secondary analysis of the 2016-17 Tanzania HIV Impact Survey. Descriptive statistics were used to summarize the participants' characteristics. Unadjusted and adjusted multinomial logistic regression models were fitted to identify factors associated with low MMC uptake among adolescent boys. Results A total of 2605 older adolescents (15-19 years) and 1296 young adolescents (10-14 years) were analyzed. The MMC uptake rates among older and young adolescents were 56.5% and 45.1%, respectively. Lower MMC uptake was found among respondents in rural areas (adjusted relative risk ratio [aRRR] = 0.40, 95% CI: 0.28-0.57), in the traditionally non-circumcising zone (aRRR = 0.30, 95% CI: 0.23-0.41), participants with no formal education (aRRR = 0.32, 95% CI: 0.23-0.41), and those living in lower wealth quintile households (aRRR = 0.20, 95% CI: 0.11-0.36). Respondents who were not covered by health insurance (aRRR = 0.67, 95% CI: 0.48-0.94) and those who had no comprehensive HIV knowledge (aRRR = 0.55, 95% CI: 0.44-0.70) were also found to have lower uptake of MMC. Conclusion To achieve and maintain high MMC coverage, MMC interventions for HIV prevention should focus on uncircumcised adolescent boys who are rural residents, of lower socioeconomic status, and residing in traditionally non-circumcising communities. Furthermore, dissemination of HIV knowledge and increasing health insurance coverage may encourage more adolescent boys to undergo MMC.
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Affiliation(s)
- Anderson Bendera
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan,Correspondence: Keiko Nakamura, Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan, Tel +81 3-5803-4048, Fax +81-3-5803-4034, Email
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
| | - Saber Al-Sobaihi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan
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