Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
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Query Trace: Kabuye G [original query] |
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HIV, syphilis, and hepatitis B virus infection and male circumcision in five Sub-Saharan African countries: Findings from the Population-based HIV Impact Assessment Surveys, 2015-2019
Peck ME , Bronson M , Djomand G , Basile I , Collins K , Kankindi I , Kayirangwa E , Malamba SS , Mugisha V , Nsanzimana S , Remera E , Kazaura KJ , Amuri M , Mmbando S , Mgomella GS , Simbeye D , Colletar Awor A , Biraro S , Kabuye G , Kirungi W , Chituwo O , Hanunka B , Kamboyi R , Mulenga L , Musonda B , Muyunda B , Nkumbula T , Malaba R , Mandisarisa J , Musuka G , Peterson AE , Toledo C . PLOS Glob Public Health 2023 3 (9) e0002326 Voluntary medical male circumcision (VMMC) has primarily been promoted for HIV prevention. Evidence also supports that male circumcision offers protection against other sexually transmitted infections. This analysis assessed the effect of circumcision on syphilis, hepatitis B virus (HBV) infection and HIV. Data from the 2015 to 2019 Population-based HIV Impact Assessments (PHIAs) surveys from Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were used for the analysis. The PHIA surveys are cross-sectional, nationally representative household surveys that include biomarking testing for HIV, syphilis and HBV infection. This is a secondary data analysis using publicly available PHIA data. Univariate and multivariable logistic regression models were created using pooled PHIA data across the five countries to assess the effect of male circumcision on HIV, active and ever syphilis, and HBV infection among sexually active males aged 15-59 years. Circumcised men had lower odds of syphilis infection, ever or active infection, and HIV, compared to uncircumcised men, after adjusting for covariates (active syphilis infection = 0.67 adjusted odds ratio (aOR), 95% confidence interval (CI), 0.52-0.87, ever having had a syphilis infection = 0.85 aOR, 95% CI, 0.73-0.98, and HIV = 0.53 aOR, 95% CI, 0.47-0.61). No difference between circumcised and uncircumcised men was identified for HBV infection (P = 0.75). Circumcised men have a reduced likelihood for syphilis and HIV compared to uncircumcised men. However, we found no statistically significant difference between circumcised and uncircumcised men for HBV infection. |
Preventing HIV among adolescent boys and young men through PEPFAR-supported voluntary medical male circumcision in 15 Sub-Saharan African Countries, 2018-2021
Peck ME , Ong K , Lucas T , Thomas AG , Wandira R , Ntwaaga B , Mkhontfo M , Zegeye T , Yohannes F , Mulatu D , Gultie T , Juma AW , Odoyo-June E , Maida A , Msungama W , Canda M , Mutandi G , Zemburuka BLT , Kankindi I , Vranken P , Maphothi N , Loykissoonlal D , Bunga S , Grund JM , Kazaura KJ , Kabuye G , Chituwo O , Muyunda B , Kamboyi R , Lingenda G , Mandisarisa J , Peterson A , Malaba R , Xaba S , Moyo T , Toledo C . AIDS Educ Prev 2023 35 67-81 Voluntary medical male circumcision (VMMC) is an HIV prevention intervention that has predominantly targeted adolescent and young men, aged 10-24 years. In 2020, the age eligibility for VMMC shifted from 10 to 15 years of age. This report describes the VMMC client age distribution from 2018 to 2021, at the site, national, and regional levels, among 15 countries in southern and eastern Africa. Overall, in 2018 and 2019, the highest proportion of VMMCs were performed among 10-14-year-olds (45.6% and 41.2%, respectively). In 2020 and 2021, the 15-19-year age group accounted for the highest proportion (37.2% and 50.4%, respectively) of VMMCs performed across all age groups. Similarly, in 2021 at the site level, 68.1% of VMMC sites conducted the majority of circumcisions among men aged 15-24 years. This analysis highlights that adolescent boys and young men are the primary recipients of VMMC receiving an important lifetime reduction in HIV risk. |
Voluntary medical male circumcisions for HIV prevention - 13 countries in eastern and southern Africa, 2017-2021
Peck ME , Ong KS , Lucas T , Harvey P , Lekone P , Letebele M , Thomas VT , Maziya V , Mkhontfo M , Gultie T , Mulatu D , Shimelis M , Zegeye T , Juma AW , Odoyo-June E , Musingila PK , Njenga J , Auld A , Kapito M , Maida A , Msungama W , Canda M , Come J , Malimane I , Aupokolo M , Zemburuka B , Kankindi I , Malamba S , Remera E , Tubane E , Machava R , Maphothi N , Vranken P , Amuri M , Kazaura KJ , Simbeye D , Alamo S , Kabuye G , Chituwo O , Kamboyi R , Masiye J , Mandisarisa J , Xaba S , Toledo C . MMWR Morb Mortal Wkly Rep 2023 72 (10) 256-260 In 2007, voluntary medical male circumcision (VMMC) was endorsed by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS after it was found to be associated with approximately a 60% reduction in the risk for female-to-male transmission of HIV (1). As a result of this endorsement, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), through partnerships with U.S. government agencies, including CDC, the U.S. Department of Defense, and the U.S. Agency for International Development, started supporting VMMCs performed in prioritized countries in southern and eastern Africa. During 2010-2016, CDC supported 5,880,372 VMMCs in 12 countries (2,3). During 2017-2021, CDC supported 8,497,297 VMMCs performed in 13 countries. In 2020, the number of VMMCs performed declined 31.8% compared with the number in 2019, primarily because of COVID-19-related disruptions to VMMC service delivery. PEPFAR 2017-2021 Monitoring, Evaluation, and Reporting data were used to provide an update and describe CDC's contribution to the scale-up of the VMMC program, which is important to meeting the 2025 Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 90% of males aged 15-59 years having access to VMMC services in prioritized countries to help end the AIDS epidemic by 2030 (4). |
Effects of COVID-19 pandemic on voluntary medical male circumcision services for HIV prevention, Sub-Saharan Africa, 2020
Peck ME , Ong KS , Lucas T , Prainito A , Thomas AG , Brun A , Kiggundu V , Yansaneh A , Busang L , Kgongwana K , Kelaphile D , Seipone K , Letebele MH , Makadzange PF , Marwiro A , Sesinyi M , Lapidos T , Lukhele N , Maziya V , Mkhontfo M , Gultie T , Mulatu D , Shimelis M , Zegeye T , Teka T , Bulterys M , Njenga JN , Odoyo-June E , Juma AW , Soo L , Talam N , Brown M , Chakare T , Nonyana N , Khoabane MA , Auld AF , Maida A , Msungama W , Kapito M , Nyirenda R , Matchere F , Odek J , Canda M , Malimane I , Come J , Gaspar N , Langa A , Aupokolo MA , Vejorerako KC , Kahindi L , Mali D , Zegeye A , Mangoya D , Zemburuka BL , Bamwesigye J , Kankindi I , Kayirangwa E , Malamba SS , Roels T , Kayonde L , Zimulinda E , Ndengo E , Nsanzimana S , Remera E , Rwibasira GN , Sangwayire B , Semakula M , Rugira E , Rugwizangoga E , Tubane E , Yoboka E , Lawrence J , Loykissoonlal D , Maphothi N , Achut V , Bunga S , Moi M , Amuri M , Kazaura K , Simbeye D , Fida N , Kayange AA , Seleman M , Akao J , Alamo ST , Kabuye G , Kyobutungi S , Makumbi FE , Mudiope P , Nantez B , Chituwo O , Godfrey L , Muyunda B , Kamboyi R , Masiye J , Lifuka E , Mandisarisa J , Mhangara M , Xaba S , Toledo C . Emerg Infect Dis 2022 28 (13) S262-s269 Beginning in March 2020, to reduce COVID-19 transmission, the US President's Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic. |
HIV incidence by male circumcision status from the population-based HIV impact assessment (PHIA) surveys-eight sub-Saharan African countries, 2015-2017
Hines JZ , Sachathep K , Pals S , Davis SM , Toledo C , Bronson M , Parekh B , Carrasco M , Xaba S , Mandisarisa J , Kamobyi R , Chituwo O , Kirungi WL , Alamo S , Kabuye G , Awor AC , Mmbando S , Simbeye D , Aupokolo MA , Zemburuka B , Nyirenda R , Msungama W , Tarumbiswa T , Manda R , Nuwagaba-Biribonwoha H , Kiggundu V , Thomas AG , Watts H , Voetsch AC , Williams DB . J Acquir Immune Defic Syndr 2021 87 S89-S96 BACKGROUND: Male circumcision (MC) offers men lifelong partial protection from heterosexually-acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally-representative samples. Data from the Population-based HIV Impact Assessments (PHIAs) were used to compare incidence by MC status in countries implementing voluntary medical MC (VMMC) programs. METHODS: Data were pooled from PHIAs conducted in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia and Zimbabwe from 2015-2017. Incidence was measured using a recent infection testing algorithm, and analyzed by self-reported MC status distinguishing between medical and non-medical MC. Country, marital status, urban setting, sexual risk behaviors, and mean population HIV viral load among women as an indicator of treatment scale-up were included in a random effects logistic regression model using pooled survey weights. Analyses were age-stratified (15-34 and 35-59 years). Annualized incidence rates and 95% confidence intervals (CIs) and incidence differences were calculated between medically circumcised and uncircumcised men. RESULTS: Men 15-34 years reporting medical MC had lower HIV incidence than uncircumcised men (0.04% [95% CI: 0.00, 0.10%] versus 0.34% [95% CI: 0.10, 0.57%], respectively; p-value = 0.01); whereas among men 35-59 years, there was no significant incidence difference (1.36% [95% CI: 0.32, 2.39%] versus 0.55% [95% CI: 0.14, 0.67%], respectively; p-value = 0.14). DISCUSSION: Medical MC was associated with lower HIV incidence in men aged 15-34 years in nationally-representative surveys in Africa. These findings are consistent with the expected ongoing VMMC program impact and highlight the importance of VMMC for the HIV response in Africa. |
Modeling the impact of voluntary medical male circumcision (VMMC) on cervical cancer in Uganda
Davis SM , Habel MA , Pretorius C , Yu T , Toledo C , Farley T , Kabuye G , Samuelson J . J Acquir Immune Defic Syndr 2020 86 (3) 323-328 BACKGROUND: In addition to providing millions of men with lifelong lower risk for HIV infection, voluntary medical male circumcision (VMMC) also provides female partners with health benefits including decreased risk for human papillomavirus (HPV) and resultant cervical cancer (CC). SETTING: We modeled potential impacts of VMMC on cervical cancer incidence and mortality in Uganda as an additional benefit beyond HIV prevention. METHODS: HPV and CC outcomes were modeled using the CC model from the Spectrum policy tool suite, calibrated for Uganda, to estimate HPV infection incidence and progression to CC, using a 50-year (2018-2067) time horizon. 2016 Demographic Health Survey data provided baseline VMMC coverage. The baseline (no VMMC scale-up beyond current coverage, minimal HPV vaccination coverage) was compared to multiple scenarios to assess the varying impact of VMMC according to different implementations of HPV vaccination and HPV screening programs. RESULTS: Without further intervention, annual CC incidence was projected to rise from 16.9 to 31.2 per 100,000 women in 2067. VMMC scale-up alone decreased 2067 annual CC incidence to 25.3, averting 13,000 deaths between 2018-2067. With rapidly-achieved 90% HPV9 vaccination coverage for adolescent girls and young women, 2067 incidence dropped below 10 per 100,000 with or without a VMMC program. With 45% vaccine coverage, the addition of VMMC scaleup decreased incidence by 2.9 per 100,000 and averted 8,000 additional deaths. Similarly, with HPV screen-and-treat without vaccination, the addition of VMMC scaleup decreased incidence by 5.1 per 100,000 and averted 10,000 additional deaths. CONCLUSIONS: Planned VMMC scale-up to 90% coverage from current levels could prevent a substantial number of CC cases and deaths in the absence of rapid scale-up of HPV vaccination to 90% coverage. |
Effectiveness of voluntary medical male circumcision for HIV prevention in Rakai, Uganda
Loevinsohn G , Kigozi G , Kagaayi J , Wawer MJ , Nalugoda F , Chang LW , Quinn TC , Serwadda D , Reynolds SJ , Nelson L , Mills L , Alamo S , Nakigozi G , Kabuye G , Ssekubugu R , Tobian AAR , Gray RH , Grabowski MK . Clin Infect Dis 2020 73 (7) e1946-e1953 BACKGROUND: The efficacy of voluntary male medical circumcision (VMMC) for HIV prevention in men was demonstrated in three randomized trials. This led to the adoption of VMMC as an integral component of the President's Emergency Plan for AIDS Relief (PEPFAR) combination HIV prevention program in sub-Saharan Africa. However, evidence on the individual-level effectiveness of VMMC programs in real world, programmatic settings is limited. METHODS: A cohort of initially uncircumcised, non-Muslim, HIV-uninfected men in the Rakai Community Cohort Study in Uganda were followed between 2009 and 2016 during VMMC scale-up. Self-reported VMMC status was collected and HIV tests performed at surveys conducted every 18 months. Multivariable Poisson regression was used to estimate the incidence rate ratio (IRR) of HIV acquisition in newly circumcised versus uncircumcised men. RESULTS: 3,916 non-Muslim men were followed for 17,088 person-years (py). There were 1338 newly reported VMMCs (9.8/100 py). Over the study period, the median age of men adopting VMMC declined from 28 years (IQR 21-35) to 22 years (IQR 18-29; p-trend <0.001). HIV incidence was 0.40/100 py (20/4992.8 py) among newly circumcised men and 0.98/100 py (118/12095.1 py) among uncircumcised men with an adjusted IRR of 0.47 (95%CI: 0.28-0.78). The effectiveness of VMMC was sustained with increasing time from surgery and was similar across age groups and calendar time. CONCLUSIONS: VMMC programs are highly effective in preventing HIV-acquisition in men. The observed effectiveness is consistent with efficacy in clinical trials and supports current recommendations that VMMC is a key component of programs to reduce HIV incidence. |
Bleeding and blood disorders in clients of voluntary medical male circumcision for HIV prevention - Eastern and Southern Africa, 2015-2016
Hinkle LE , Toledo C , Grund JM , Byams VR , Bock N , Ridzon R , Cooney C , Njeuhmeli E , Thomas AG , Odhiambo J , Odoyo-June E , Talam N , Matchere F , Msungama W , Nyirenda R , Odek J , Come J , Canda M , Wei S , Bere A , Bonnecwe C , Choge IA , Martin E , Loykissoonlal D , Lija GJI , Mlanga E , Simbeye D , Alamo S , Kabuye G , Lubwama J , Wamai N , Chituwo O , Sinyangwe G , Zulu JE , Ajayi CA , Balachandra S , Mandisarisa J , Xaba S , Davis SM . MMWR Morb Mortal Wkly Rep 2018 67 (11) 337-339 Male circumcision reduces the risk for female-to-male human immunodeficiency virus (HIV) transmission by approximately 60% (1) and has become a key component of global HIV prevention programs in countries in Eastern and Southern Africa where HIV prevalence is high and circumcision coverage is low. Through September 2017, the President's Emergency Plan for AIDS Relief (PEPFAR) had supported 15.2 million voluntary medical male circumcisions (VMMCs) in 14 priority countries in Eastern and Southern Africa (2). Like any surgical intervention, VMMC carries a risk for complications or adverse events. Adverse events during circumcision of males aged >/=10 years occur in 0.5% to 8% of procedures, though the majority of adverse events are mild (3,4). To monitor safety and service quality, PEPFAR tracks and reports qualifying notifiable adverse events. Data reported from eight country VMMC programs during 2015-2016 revealed that bleeding resulting in hospitalization for >/=3 days was the most commonly reported qualifying adverse event. In several cases, the bleeding adverse event revealed a previously undiagnosed or undisclosed bleeding disorder. Bleeding adverse events in men with potential bleeding disorders are serious and can be fatal. Strategies to improve precircumcision screening and performance of circumcisions on clients at risk in settings where blood products are available are recommended to reduce the occurrence of these adverse events or mitigate their effects (5). |
Scale-up of voluntary medical male circumcision services for HIV prevention - 12 countries in southern and eastern Africa, 2013-2016
Hines JZ , Ntsuape OC , Malaba K , Zegeye T , Serrem K , Odoyo-June E , Nyirenda RK , Msungama W , Nkanaunena K , Come J , Canda M , Nhaguiombe H , Shihepo EK , Zemburuka BLT , Mutandi G , Yoboka E , Mbayiha AH , Maringa H , Bere A , Lawrence JJ , Lija GJI , Simbeye D , Kazaura K , Mwiru RS , Talisuna SA , Lubwama J , Kabuye G , Zulu JE , Chituwo O , Mumba M , Xaba S , Mandisarisa J , Baack BN , Hinkle L , Grund JM , Davis SM , Toledo C . MMWR Morb Mortal Wkly Rep 2017 66 (47) 1285-1290 Countries in Southern and Eastern Africa have the highest prevalence of human immunodeficiency virus (HIV) infection in the world; in 2015, 52% (approximately 19 million) of all persons living with HIV infection resided in these two regions.* Voluntary medical male circumcision (VMMC) reduces the risk for heterosexually acquired HIV infection among males by approximately 60% (1). As such, it is an essential component of the Joint United Nations Programme on HIV/AIDS (UNAIDS) strategy for ending acquired immunodeficiency syndrome (AIDS) by 2030 (2). Substantial progress toward achieving VMMC targets has been made in the 10 years since the World Health Organization (WHO) and UNAIDS recommended scale-up of VMMC for HIV prevention in 14 Southern and Eastern African countries with generalized HIV epidemics and low male circumcision prevalence (3).(dagger) This has been enabled in part by nearly $2 billion in cumulative funding through the President's Emergency Plan for AIDS Relief (PEPFAR), administered through multiple U.S. governmental agencies, including CDC, which has supported nearly half of all PEPFAR-supported VMMCs to date. Approximately 14.5 million VMMCs were performed globally during 2008-2016, which represented 70% of the original target of 20.8 million VMMCs in males aged 15-49 years through 2016 (4). Despite falling short of the target, these VMMCs are projected to avert 500,000 HIV infections by the end of 2030 (4). However, UNAIDS has estimated an additional 27 million VMMCs need to be performed by 2021 to meet the Fast Track targets (2). This report updates a previous report covering the period 2010-2012, when VMMC implementing partners supported by CDC performed approximately 1 million VMMCs in nine countries (5). During 2013-2016, these implementing partners performed nearly 5 million VMMCs in 12 countries. Meeting the global target will require redoubling current efforts and introducing novel strategies that increase demand among subgroups of males who have historically been reluctant to undergo VMMC. |
Notes from the field: Tetanus cases after voluntary medical male circumcision for HIV prevention - Eastern and Southern Africa, 2012-2015
Grund JM , Toledo C , Davis SM , Ridzon R , Moturi E , Scobie H , Naouri B , Reed JB , Njeuhmeli E , Thomas AG , Benson FN , Sirengo MW , Muyenzi LN , Lija GJ , Rogers JH , Mwanasalli S , Odoyo-June E , Wamai N , Kabuye G , Zulu JE , Aceng JR , Bock N . MMWR Morb Mortal Wkly Rep 2016 65 (2) 36-7 Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60% (1), and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision (2). As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs (3). |
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