Uptake of medical male circumcision with household-based testing, and the association of traditional male circumcision and HIV infection
File(s)
Supporting information
Author(s)
Type
Journal Article
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.
Date Issued
2023-04-01
Date Acceptance
2022-12-02
Citation
AIDS, 2023, 37 (5), pp.795-802
ISSN
0269-9370
Publisher
Lippincott, Williams & Wilkins
Start Page
795
End Page
802
Journal / Book Title
AIDS
Volume
37
Issue
5
Copyright Statement
© 2022 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in AIDS 37(5):p 795-802, April 1, 2023, https://dx.doi.org/10.1097/QAD.0000000000003463
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36727597
PII: 00002030-990000000-00176
Subjects
Acquired Immunodeficiency Syndrome
Circumcision, Male
HIV Infections
Humans
Male
South Africa
Zambia
Publication Status
Published
Coverage Spatial
England