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基于人群的艾滋病毒影响评估调查中按男性包皮环切状况划分的艾滋病毒发病率-2015-2017 年八个撒哈拉以南非洲国家。

HIV Incidence by Male Circumcision Status From the Population-Based HIV Impact Assessment Surveys-Eight Sub-Saharan African Countries, 2015-2017.

机构信息

Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.

ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, New York.

出版信息

J Acquir Immune Defic Syndr. 2021 Aug 1;87(Suppl 1):S89-S96. doi: 10.1097/QAI.0000000000002658.


DOI:10.1097/QAI.0000000000002658
PMID:33765683
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11187824/
Abstract

BACKGROUND: Male circumcision (MC) offers men lifelong partial protection from heterosexually acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally representative samples. Data from the population-based HIV impact assessments were used to compare HIV incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. METHODS: Data were pooled from population-based HIV impact assessments conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2017. Incidence was measured using a recent infection testing algorithm and analyzed by self-reported MC status distinguishing between medical and nonmedical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random-effects logistic regression model using pooled survey weights. Analyses were age stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. RESULTS: Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men [0.04% (95% CI: 0.00% to 0.10%) versus 0.34% (95% CI: 0.10% to 0.57%), respectively; P value = 0.01]; whereas among men 35-59 years, there was no significant incidence difference [1.36% (95% CI: 0.32% to 2.39%) versus 0.55% (95% CI: 0.14% to 0.67%), respectively; P value = 0.14]. DISCUSSION: Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa.

摘要

背景:男性包皮环切术(MC)可为男性提供终生的部分保护,使其免受异性性传播感染艾滋病毒。在全国代表性样本中,MC 对艾滋病毒发病率的影响尚未量化。本研究使用基于人群的艾滋病毒影响评估数据,比较了在实施自愿医疗 MC(VMMC)计划的国家中,按 MC 状况划分的艾滋病毒发病率。

方法:本研究数据来自于 2015 年至 2017 年期间在斯威士兰、莱索托、马拉维、纳米比亚、坦桑尼亚、乌干达、赞比亚和津巴布韦进行的基于人群的艾滋病毒影响评估。使用最近感染检测算法测量发病率,并按自我报告的 MC 状态进行分析,区分医疗和非医疗 MC。国家、婚姻状况、城市环境、性风险行为以及作为治疗扩大规模指标的女性人群 HIV 病毒载量均值均包含在使用汇总调查权重的随机效应逻辑回归模型中。分析按年龄分层(15-34 岁和 35-59 岁)。计算了报告接受医疗 MC 和未接受 MC 的男性之间的年化发病率、95%置信区间(CI)和发病率差异。

结果:报告接受医疗 MC 的 15-34 岁男性的艾滋病毒发病率低于未接受 MC 的男性[0.04%(95%CI:0.00%至 0.10%)与 0.34%(95%CI:0.10%至 0.57%),P 值=0.01];而在 35-59 岁男性中,发病率无显著差异[1.36%(95%CI:0.32%至 2.39%)与 0.55%(95%CI:0.14%至 0.67%),P 值=0.14]。

讨论:在非洲全国代表性调查中,15-34 岁男性接受医疗 MC 与艾滋病毒发病率较低相关。这些发现与预期的 VMMC 计划的持续影响一致,并强调了 VMMC 在非洲艾滋病毒应对中的重要性。

相似文献

[1]
HIV Incidence by Male Circumcision Status From the Population-Based HIV Impact Assessment Surveys-Eight Sub-Saharan African Countries, 2015-2017.

J Acquir Immune Defic Syndr. 2021-8-1

[2]
Evidence that promotion of male circumcision did not lead to sexual risk compensation in prioritized Sub-Saharan countries.

PLoS One. 2017-4-25

[3]
Association of the ANRS-12126 male circumcision project with HIV levels among men in a South African township: evaluation of effectiveness using cross-sectional surveys.

PLoS Med. 2013-9-3

[4]
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[5]
Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa.

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[6]
Correlates of male circumcision in Eastern and Southern African countries: establishing a baseline prior to VMMC Scale-up.

PLoS One. 2014-6-23

[7]
Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets.

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[8]
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[9]
Sequential Cross-Sectional Surveys in Orange Farm, a Township of South Africa, Revealed a Constant Low Voluntary Medical Male Circumcision Uptake among Adults despite Demand Creation Campaigns and High Acceptability.

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[10]
Circumcision preference among women and uncircumcised men prior to scale-up of male circumcision for HIV prevention in Kisumu, Kenya.

AIDS Care. 2012

引用本文的文献

[1]
Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015-2019.

Emerg Infect Dis. 2023-11

[2]
Trends in HIV prevalence, incidence, and progress towards the UNAIDS 95-95-95 targets in Malawi among individuals aged 15-64 years: population-based HIV impact assessments, 2015-16 and 2020-21.

Lancet HIV. 2023-9

[3]
HIV prevention in Africa: is VMMC useful and acceptable?

Int J Impot Res. 2023-5

[4]
Inferring population HIV incidence trends from surveillance data of recent HIV infection among HIV testing clients.

AIDS. 2021-11-15

本文引用的文献

[1]
Population Viral Load, Viremia, and Recent HIV-1 Infections: Findings From Population-Based HIV Impact Assessments (PHIAs) in Zimbabwe, Malawi, and Zambia.

J Acquir Immune Defic Syndr. 2021-8-1

[2]
Depletion-of-susceptibles bias in influenza vaccine waning studies: how to ensure robust results.

Epidemiol Infect. 2019-11-27

[3]
Impact of combination HIV interventions on HIV incidence in hyperendemic fishing communities in Uganda: a prospective cohort study.

Lancet HIV. 2019-9-15

[4]
Field Validation of Limiting-Antigen Avidity Enzyme Immunoassay to Estimate HIV-1 Incidence in Cross-Sectional Survey in Swaziland.

AIDS Res Hum Retroviruses. 2019-10

[5]
Short Communication: Assessing Estimates of HIV Incidence with a Recent Infection Testing Algorithm That Includes Viral Load Testing and Exposure to Antiretroviral Therapy.

AIDS Res Hum Retroviruses. 2018-10

[6]
HIV Population Surveys - Bringing Precision to the Global Response.

N Engl J Med. 2018-5-17

[7]
HIV incidence in western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis.

Lancet HIV. 2018-4-9

[8]
Agreement between self-reported and physically verified male circumcision status in Nyanza region, Kenya: Evidence from the TASCO study.

PLoS One. 2018-2-12

[9]
Status of HIV Epidemic Control Among Adolescent Girls and Young Women Aged 15-24 Years - Seven African Countries, 2015-2017.

MMWR Morb Mortal Wkly Rep. 2018-1-12

[10]
Effect of population viral load on prospective HIV incidence in a hyperendemic rural African community.

Sci Transl Med. 2017-12-13

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