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Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis.
Awad, Susanne F; Sgaier, Sema K; Lau, Fiona K; Mohamoud, Yousra A; Tambatamba, Bushimbwa C; Kripke, Katharine E; Thomas, Anne G; Bock, Naomi; Reed, Jason B; Njeuhmeli, Emmanuel; Abu-Raddad, Laith J.
Affiliation
  • Awad SF; Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
  • Sgaier SK; Surgo Foundation, Washington, District of Columbia, United States of America.
  • Lau FK; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
  • Mohamoud YA; Department of Global Health, University of Washington, Seattle, Washington, United States of America.
  • Tambatamba BC; Surgo Foundation, Washington, District of Columbia, United States of America.
  • Kripke KE; Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
  • Thomas AG; Ministry of Community Development and Mother and Child Health, Lusaka, Zambia.
  • Bock N; Health Policy Initiative, Avenir Health, Washington, District of Columbia, United States of America.
  • Reed JB; Naval Health Research Center, U.S. Department of Defense, San Diego, California, United States of America.
  • Njeuhmeli E; Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
  • Abu-Raddad LJ; Jhpiego, Washington, District of Columbia, United States of America.
PLoS One ; 12(1): e0170641, 2017.
Article in En | MEDLINE | ID: mdl-28118387
BACKGROUND: The epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example. METHODS AND FINDINGS: We used the Age-Structured Mathematical (ASM) model to evaluate, over an intermediate horizon (2010-2025), the effectiveness (number of VMMCs needed to avert one HIV infection) of VMMC scale-up scenarios with varying proportions of HIV-positive males. The model was calibrated by fitting to HIV prevalence time trend data from 1990 to 2014. We assumed that inclusivity of HIV positive males may benefit VMMC programs by increasing VMMC uptake among higher risk males, or by circumcision reducing HIV male-to-female transmission risk. All analyses were generated assuming no further antiretroviral therapy (ART) scale-up. The number of VMMCs needed to avert one HIV infection was projected to increase from 12.2 VMMCs per HIV infection averted, in a program that circumcises only HIV-negative males, to 14.0, in a program that includes HIV-positive males. The proportion of HIV-positive males was based on their representation in the population (e.g. 12.6% of those circumcised in 2010 would be HIV-positive based on HIV prevalence among males of 12.6% in 2010). However, if a program that only reaches out to HIV-negative males is associated with 20% lower uptake among higher-risk males, the effectiveness would be 13.2 VMMCs per infection averted. If improved inclusivity of HIV-positive males is associated with 20% higher uptake among higher-risk males, the effectiveness would be 12.4. As the assumed VMMC efficacy against male-to-female HIV transmission was increased from 0% to 20% and 46%, the effectiveness of circumcising regardless of HIV status improved from 14.0 to 11.5 and 9.1, respectively. The reduction in the HIV incidence rate among females increased accordingly, from 24.7% to 34.8% and 50.4%, respectively. CONCLUSION: Improving inclusivity of males in VMMC programs regardless of HIV status increases VMMC effectiveness, if there is moderate increase in VMMC uptake among higher-risk males and/or if there is moderate efficacy for VMMC against male-to-female transmission. In these circumstances, VMMC programs can reduce the HIV incidence rate in males by nearly as much as expected by some ART programs, and additionally, females can benefit from the intervention nearly as much as males.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Acceptance of Health Care / HIV Infections / HIV Seropositivity / Circumcision, Male / Health Promotion / Models, Theoretical Type of study: Evaluation_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2017 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Acceptance of Health Care / HIV Infections / HIV Seropositivity / Circumcision, Male / Health Promotion / Models, Theoretical Type of study: Evaluation_studies / Incidence_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2017 Document type: Article Affiliation country: Country of publication: