Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 3 Corporate Blvd NE, US1-1, Atlanta, GA, 30329, USA.
Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Pretoria, South Africa.
Curr HIV/AIDS Rep. 2022 Dec;19(6):537-547. doi: 10.1007/s11904-022-00640-y. Epub 2022 Nov 11.
Since 2007, voluntary medical male circumcision (VMMC) programs have been associated with substantially reduced HIV incidence across 15 prioritized countries in Eastern and Southern Africa. Drawing on the programmatic experience of global VMMC leaders, this report reviews progress made in the first 15 years of the program, describes programmatic and research gaps, and presents considerations to maximize the impact of VMMC.
Overall, key programmatic and research gaps include a lack of robust male circumcision coverage estimates due to limitations to the data and a lack of standardized approaches across programs; challenges enhancing VMMC uptake include difficulties reaching populations at higher risk for HIV infection and men 30 years and older; limitations to program and procedural quality and safety including variations in approaches used by programs; and lastly, sustainability with limited evidence-based practices. Considerations to address these gaps include the need for global guidance on estimating coverage, conducting additional research on specific sub-populations to improve VMMC uptake, implementation of responsive and comprehensive approaches to adverse event surveillance, and diversifying financing streams to progress towards sustainability. This report's findings may help establish a global VMMC research and programmatic agenda to inform policy, research, and capacity-building activities at the national and global levels.
目的综述：自 2007 年以来，在东非和南非的 15 个重点国家，自愿男性包皮环切术（VMMC）项目与大幅降低 HIV 发病率有关。本报告借鉴全球 VMMC 领导者的项目经验，回顾了该项目前 15 年取得的进展，描述了项目和研究差距，并提出了一些考虑因素，以最大限度地提高 VMMC 的效果。
最新发现：总体而言，关键的项目和研究差距包括由于数据限制和各项目之间缺乏标准化方法，导致缺乏强有力的男性包皮环切覆盖率估计；难以提高 VMMC 普及率的挑战包括难以接触到感染 HIV 风险较高的人群和 30 岁及以上的男性；项目和程序质量及安全性方面的限制，包括各项目采用的方法不同；以及可持续性方面的证据有限。为了解决这些差距，需要在全球范围内就估计覆盖率提供指导，对特定亚人群进行额外的研究以提高 VMMC 的普及率，实施有针对性和全面的不良事件监测方法，以及多样化的融资渠道，以实现可持续性。本报告的调查结果可能有助于制定全球 VMMC 研究和项目议程，为国家和全球各级的政策、研究和能力建设活动提供信息。
