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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial
Lancet, Volume 369, No. 9562, Year 2007
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Description
Background: Ecological and observational studies suggest that male circumcision reduces the risk of HIV acquisition in men. Our aim was to investigate the effect of male circumcision on HIV incidence in men. Methods: 4996 uncircumcised, HIV-negative men aged 15-49 years who agreed to HIV testing and counselling were enrolled in this randomised trial in rural Rakai district, Uganda. Men were randomly assigned to receive immediate circumcision (n=2474) or circumcision delayed for 24 months (2522). HIV testing, physical examination, and interviews were repeated at 6, 12, and 24 month follow-up visits. The primary outcome was HIV incidence. Analyses were done on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov, with the number NCT00425984. Findings: Baseline characteristics of the men in the intervention and control groups were much the same at enrolment. Retention rates were much the same in the two groups, with 90-92% of participants retained at all time points. In the modified intention-to-treat analysis, HIV incidence over 24 months was 0·66 cases per 100 person-years in the intervention group and 1·33 cases per 100 person-years in the control group (estimated efficacy of intervention 51%, 95% CI 16-72; p=0·006). The as-treated efficacy was 55% (95% CI 22-75; p=0·002); efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60% (30-77; p=0·003). HIV incidence was lower in the intervention group than it was in the control group in all sociodemographic, behavioural, and sexually transmitted disease symptom subgroups. Moderate or severe adverse events occurred in 84 (3·6%) circumcisions; all resolved with treatment. Behaviours were much the same in both groups during follow-up. Interpretation: Male circumcision reduced HIV incidence in men without behavioural disinhibition. Circumcision can be recommended for HIV prevention in men. © 2007 Elsevier Ltd. All rights reserved.
Authors & Co-Authors
Gray, Ronald H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Kigozi, Godfrey G.
Uganda, Kalisizo
Rakai Health Sciences Program
Serwadda, David Musoke
Uganda, Kampala
Makerere University
Makumbi, Fredrick Edward
Uganda, Kampala
Makerere University
Watya, Stephen
Uganda, Kampala
Makerere University
Nalugoda, Fred Kakaire
Uganda, Kalisizo
Rakai Health Sciences Program
Kiwanuka, Noah
Uganda, Kalisizo
Rakai Health Sciences Program
Moulton, Lawrence H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Chaudhary, Mohammad Ashraf
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Chen, Michael Z.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Sewankambo, Nelson K.
Uganda, Kampala
Makerere University
Wabwire-Mangen, Fred
Uganda, Kampala
Makerere University
Bacon, Melanie C.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Williams, Carolyn Fm
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Opendi, Pius
Uganda, Kalisizo
Rakai Health Sciences Program
Reynolds, Steven James
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins Medical Institutions
Laeyendecker, Oliver B.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins Medical Institutions
Quinn, Thomas Charles
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins Medical Institutions
Wawer, Maria J.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Statistics
Citations: 2,077
Authors: 19
Affiliations: 5
Identifiers
Doi:
10.1016/S0140-6736(07)60313-4
ISSN:
01406736
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Uganda
Participants Gender
Male