Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

Hôpital Ambroise-Paré, Assitance Publique-Hôpitaux de Paris, Boulogne, France.
PLoS Medicine (Impact Factor: 14). 12/2005; 2(11):e298. DOI: 10.1371/journal.pmed.0020298
Source: PubMed

ABSTRACT Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis.
A total of 3,274 uncircumcised men, aged 18-24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR) of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 - RR. The trial was stopped at the interim analysis, and the mean (interquartile range) follow-up was 18.1 mo (13.0-21.0) when the data were analyzed. There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%). When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%-77%).
Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa. (Preliminary and partial results were presented at the International AIDS Society 2005 Conference, on 26 July 2005, in Rio de Janeiro, Brazil.).

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Available from: Dirk Taljaard, Jul 28, 2015
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    • "One of the major success stories in HIV prevention was of three trials in Kenya, South Africa and Uganda that demonstrated that voluntary medical male circumcision (VMMC) reduced HIV acquisition among heterosexual men by up to 60% (Auvert et al. 2005; Bailey et al. 2007; Grey et al. 2007; Padian et al. 2011). Mathematical modelling indicated that the potential public health benefit of VMMC could significantly reduce HIV prevalence in men, which may also indirectly benefit women (Njeuhmeli et al. 2011; Williams et al. 2006). "
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    ABSTRACT: While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men's decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them.
    Culture Health & Sexuality 01/2015; DOI:10.1080/13691058.2014.992045 · 1.55 Impact Factor
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    • "And just three evaluations of medical male circumcision (Auvert et al. 2005; Bailey et al. 2007; Gray et al. 2007) in Africa made male circumcision a core strategy for HIV prevention for prominent funders, including the President's Emergency Plan for AIDS Relief (PEPFAR) and the Bill & Melinda Gates Foundation. Some argue that the referee process is responsible for ensuring the quality of the results that are ultimately published, and thus replication is not necessary. "
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    ABSTRACT: In this paper, we make the case for replication as a crucial methodology for validating research used for evidence-based policymaking, especially in low- and middle-income countries. We focus on internal replication or the reanalysis of original data to address an original evaluation or research question. We review the current state of replication in the social sciences and present data on the trends among academic publications. We then discuss four challenges facing empirical research that internal replication can help to address. We offer a new typology of replication approaches for addressing these challenges. The types – pure replication, measurement and estimation analysis, and theory of change analysis – highlight that internal replication can test for consistency and statistical robustness but can and should also be used to ensure that a study fully explores possible theories of change in order to draw appropriate conclusions and recommendations for policymaking and programme design.
    Journal of Development Effectiveness 08/2014; 6(3):215-235. DOI:10.1080/19439342.2014.944555 · 0.92 Impact Factor
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    • "In relation to circumcision and HIV status, multivariate results showed that circumcised men were more likely to be HIV negative compared with the uncircumcised. These findings are consistent with some randomized controlled (Auvert, Taljaard et al., 2005; Bailey, Moses et al., 2007; Gray, Kigozi et al., 2007) that have shown a protective effect of circumcision against heterosexual HIV infection from infected women to men. These results were observed even though the odds of risky sexual behaviors were higher among the circumcised men. "
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    ABSTRACT: Safe Male Circumcision is a known intervention in prevention of heterosexual HIV acquisition. However, since the roll-out of the male circumcision policy in Uganda, concerns that circumcision may lead to behavior disinhibition are rife. We assess the association between male circumcision, risky sexual behavior and HIV status among Ugandan men. Data are from AIDS Indicator Survey 2011 with 7,969 ever sexually active men aged 15-59 years. The prevalence of circumcision was 28% and most common risky sexual behaviors were; multiple life-time sexual partners, non marital sex and non-use of condoms. Adjusted logistic regression analyses showed that multiple life-time partners, OR=1.47 (95%CI: 1.28-1.68), engagement in non marital sex, OR=1.25 (95%CI: 1.03-1.50), and non-use of condom at such sex were significantly higher among the circumcised. HIV prevalence was lower among the circumcised even with risky sexual behaviors. There is need for continued sensitization on circumcision and re-packaging of the circumcision messages.
    Population Association of America 2014 Annual Meeting, Boston, MA USA; 05/2014
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