Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA.
Modeling, Planning and Policy Analysis Center of Excellence, Avenir Health, Glastonbury, CT.
J Acquir Immune Defic Syndr. 2021 Mar 1;86(3):323-328. doi: 10.1097/QAI.0000000000002552.
BACKGROUND: In addition to providing millions of men with lifelong lower risk for HIV infection, voluntary medical male circumcision (VMMC) also provides female partners with health benefits including decreased risk for human papillomavirus (HPV) and resultant cervical cancer (CC). SETTING: We modeled potential impacts of VMMC on CC incidence and mortality in Uganda as an additional benefit beyond HIV prevention. METHODS: HPV and CC outcomes were modeled using the CC model from the Spectrum policy tool suite, calibrated for Uganda, to estimate HPV infection incidence and progression to CC, using a 50-year (2018-2067) time horizon. 2016 Demographic Health Survey data provided baseline VMMC coverage. The baseline (no VMMC scale-up beyond current coverage, minimal HPV vaccination coverage) was compared with multiple scenarios to assess the varying impact of VMMC according to different implementations of HPV vaccination and HPV screening programs. RESULTS: Without further intervention, annual CC incidence was projected to rise from 16.9 to 31.2 per 100,000 women in 2067. VMMC scale-up alone decreased 2067 annual CC incidence to 25.3, averting 13,000 deaths between 2018 and 2067. With rapidly-achieved 90% HPV9 vaccination coverage for adolescent girls and young women, 2067 incidence dropped below 10 per 100,000 with or without a VMMC program. With 45% vaccine coverage, the addition of VMMC scaleup decreased incidence by 2.9 per 100,000 and averted 8000 additional deaths. Similarly, with HPV screen-and-treat without vaccination, the addition of VMMC scaleup decreased incidence by 5.1 per 100,000 and averted 10,000 additional deaths. CONCLUSIONS: Planned VMMC scale-up to 90% coverage from current levels could prevent a substantial number of CC cases and deaths in the absence of rapid scale-up of HPV vaccination to 90% coverage.
背景：除了为数百万人提供终生感染艾滋病毒风险降低之外，自愿男性包皮环切术（VMMC）还为女性伴侣带来了健康益处，包括降低人乳头瘤病毒（HPV）感染风险和由此导致的宫颈癌（CC）风险。 地点：我们将 VMMC 对乌干达 CC 发病率和死亡率的潜在影响建模为 HIV 预防之外的附加益处。 方法：使用来自 Spectrum 政策工具套件的 CC 模型对 HPV 和 CC 结果进行建模，该模型经过校准以适用于乌干达，以估计 HPV 感染的发生率和进展为 CC 的情况，使用 50 年（2018-2067 年）的时间范围。2016 年人口与健康调查数据提供了 VMMC 覆盖率的基线。将基线（没有超出当前覆盖范围的 VMMC 扩大，HPV 疫苗接种覆盖率最低）与多种情况进行比较，以根据 HPV 疫苗接种和 HPV 筛查计划的不同实施情况评估 VMMC 的不同影响。 结果：如果不采取进一步的干预措施，预计 2067 年每年的 CC 发病率将从每 100,000 名妇女 16.9 例上升至 31.2 例。单独扩大 VMMC 规模可将 2067 年的年度 CC 发病率降低至 25.3 例，在 2018 年至 2067 年期间避免了 13,000 人死亡。如果青少年女孩和年轻妇女迅速实现 90%的 HPV9 疫苗接种覆盖率，无论是否有 VMMC 计划，2067 年的发病率都将低于每 100,000 人 10 例。如果疫苗覆盖率为 45%，则扩大 VMMC 规模可使发病率降低 2.9 例每 100,000 人，并避免另外 8000 人死亡。同样，如果进行 HPV 筛查和治疗而不接种疫苗，则扩大 VMMC 规模可使发病率降低 5.1 例每 100,000 人，并避免另外 10,000 人死亡。 结论：从目前的水平计划将 VMMC 规模扩大到 90%的覆盖范围，可以在 HPV 疫苗接种迅速扩大到 90%的覆盖范围之前，预防大量 CC 病例和死亡。
J Acquir Immune Defic Syndr. 2021-3-1
Curr HIV/AIDS Rep. 2022-12
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