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