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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The long-term efficacy of medical male circumcision against HIV acquisition
AIDS, Volume 27, No. 18, Year 2013
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Description
Background: In three randomized trials, medical male circumcision (MMC) reduced HIV acquisition in heterosexual men in sub-Saharan Africa by approximately 60%, after 21-24 months of follow-up. We estimated the 72-month efficacy of MMC against HIV among men retained in the Kisumu randomized trial, in which HIV acquisition was reduced by 60% after 24 months. Methods: From 2002 to 2005, 2784 men aged 18-24 were enrolled and randomized 1 : 1 to immediate circumcision or control. At trial end in December 2006, control men were offered free circumcision. Follow-up continued to September 2010. Cox proportional hazards regression incorporating stabilized inverse probability of treatment and censoring weights generated through marginal structural modeling, was used to account for potential time-varying confounding and censoring to estimate the efficacy of MMC on HIV risk. Results: The cumulative 72-month HIV incidence was 7.21% [95% confidence interval (CI): 5.98-8.68%]: 4.81% among circumcised men, 11.0% among uncircumcised men. The crude hazard ratio of HIV seroconversion for circumcised vs. uncircumcised men was 0.38 [95% CI: 0.26-0.55]. In weight-adjusted Cox regression, the hazard ratio was 0.42 [95% CI: 0.26-0.66]. Conclusion: The efficacy ofMMCwas sustained at 58% at 72 months, similar to overall findings of the three trials under conditions of randomization. These findings provide an estimate of the long-term efficacy of circumcision against HIV acquisition. Our results support programmatic scale-up recommendations that are based on assumptions of sustained efficacy. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Mehta, Supriya Dinesh
United States, Chicago
University of Illinois at Chicago
Moses, Stephen
Canada, Winnipeg
University of Manitoba
Agot, Kawango E.
Kenya, Kisumu
Impact Research and Development Organization
Odoyo-June, Elijah
Canada, Winnipeg
University of Manitoba
Li, Hong
United States, Chicago
University of Illinois at Chicago
MacLean, Ian W.
Canada, Winnipeg
University of Manitoba
Hedeker, Donald
United States, Chicago
University of Illinois at Chicago
Bailey, Robert C.
United States, Chicago
University of Illinois at Chicago
Statistics
Citations: 71
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1097/01.aids.0000432444.30308.2d
e-ISSN:
14735571
Research Areas
Environmental
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Participants Gender
Male