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: 14.43). 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, Sep 27, 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; 17(7):1-12. DOI:10.1080/13691058.2014.992045 · 1.55 Impact Factor
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    • "Three randomized controlled trials conducted in Uganda, Kenya and South Africa between 2002 and 2006 demonstrated the efficacy of voluntary medical male circumcision (VMMC) to partially protect men against HIV infection acquired through vaginal sex [1]–[4]. In these trials, infection rates in medically circumcised men were 50–60% lower than those among the uncircumcised group and VMMC services are now being scaled-up in 14 sub-Saharan countries, including Kenya [5]. "
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    ABSTRACT: Background: Uptake of VMMC among adult men has been lower than desired in Nyanza, Kenya. Previous research has identified several barriers to uptake but qualitative exploration of barriers is limited and evidence-informed interventions have not been fully developed. This study was conducted in 2012 to 1) increase understanding of barriers to VMMC and 2) to inform VMMC rollout through the identification of evidence-informed interventions among adult men at high risk of HIV in Nyanza Province, Kenya. Methods: Focus groups (n=8) and interviews were conducted with circumcised (n=8) and uncircumcised men (n=14) from the two districts in Nyanza, Kenya. Additional interviews were conducted with female partners (n=20), health providers (n=12), community leaders (n=12) and employers (n=12). Interview and focus group guides included questions about individual, interpersonal and societal barriers to VMMC uptake and ways to overcome them. Inductive thematic coding and analysis were conducted through a standard iterative process. Results: Two primary concerns with VMMC emerged 1) financial issues including missing work, losing income during the procedure and healing and family survival during the recovery period and 2) fear of pain during and after the procedure. Key interventions to address financial concerns included: a food or cash transfer, education on saving and employer-based benefits. Interventions to address concerns about pain included refining the content of demand creation and counseling messages about pain and improving the ways these messages are delivered. Conclusions: Men need accurate and detailed information on what to expect during and after VMMC regarding both pain and time away from work. This information should be incorporated into demand creation activities for men considering circumcision. Media content should frankly and correctly address these concerns. Study findings support scale up and/or further improvement of these ongoing educational programs and specifically targeting the demand creation period.
    PLoS ONE 12/2014; DOI:10.1371/journal.pone.0098221 · 3.23 Impact Factor
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    • "One of the key pillars to achieving this goal includes scaling up voluntary medical male circumcision (VMMC) in sub-Saharan Africa. Multiple observational studies [2,3] and randomized trials (RCTs) [4-6] have conclusively demonstrated that VMMC can reduce the lifetime risk of male acquisition of HIV by about 60% [7]. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have endorsed innovative approaches to VMMC uptake in 13 priority countries in which HIV incidence remains high, but the prevalence of male circumcision is low [8]. "
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    ABSTRACT: Voluntary medical male circumcision has been conclusively demonstrated to reduce the lifetime risk of male acquisition of HIV. The strategy has been adopted as a component of a comprehensive strategy towards achieving an AIDS-free generation. A number of countries in which prevalence of HIV is high and circumcision is low have been identified as a priority, where innovative approaches to scale-up are currently being explored. Rwanda, as one of the priority countries, has faced a number of challenges to successful scale-up. We discuss here how simplifications in the procedure, addressing a lack of healthcare infrastructure and mobilizing resources, and engaging communities of both men and women have permitted Rwanda to move forward with more optimism in its scale-up tactics. Examples from Rwanda are used to highlight how these barriers can and should be addressed.
    BMC Medicine 10/2014; 12(1):184. DOI:10.1186/s12916-014-0184-4 · 7.25 Impact Factor
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