In a study appearing in the July 12 problem of JAMA, an HIV/AIDS theme problem, Xiangrong Kong, Ph.D., regarding the Johns Hopkins Bloomberg class of Public wellness, Baltimore, and colleagues examined whether increasing community male that is medical and antiretroviral therapy (ART) coverage had been associated with minimal community HIV incidence in Uganda.
Randomized trials have shown that medical male circumcision (MMC) reduces HIV that is male purchase 50 % to 60 %, and that very early initiation of ART reduces HIV transmission by significantly more than 90 % in HIV-discordant couples. You will find limited information in the effect that is population-level of of these interventions in sub-Saharan Africa. Such evaluation is essential for resource and preparation allocation.
Using information from population-based studies carried out from 1999 through 2013 in 45 Rakai that is rural communities, community-level ART and MMC coverage, sociodemographics, intimate actions, and HIV prevalence and incidence were believed in 3 periods: ahead of the option of ART and MMC (1999-2004), during very early accessibility to ART and MMC (2004-2007), and during mature system scale-up (2007-2013).
From 1999 through 2013, 44,688 persons took part in 1 or more studies. Median community MMC protection increased from 19 per cent to 39 %, and community that is median coverage rose from 0 % to 21 per cent in men and from 0 % to 26 percent in females. Median community HIV incidence declined from 1.25 to 0.84 per 100 person-years in males, and from 1.25 to 0.99 per 100 person-years in females. Analysis suggested that increasing protection that is community-level of ended up being related to significant reductions in male community HIV incidence. For instance, in communities with MMC significantly more than 40 %, male HIV incidence ended up being 0.66 per 100 person-years lower than in communities with MMC protection 10 percent or less.
"This difference is substantial to these communities and implies that increasing MMC coverage a lot more than 40 percent could reduce incidence that is male about 39 percent at a population-level. This is comparable with the expected reduction in individual HIV purchase danger connected with comparable ART protection in South Africa," the authors write.
"Because MMC provides protection that is direct male HIV acquisition, this association is plausible and in line with the estimated associations of increasing MMC protection with male HIV prevalence from cross-sectional analyses in South Africa. Feminine community HIV incidence was not considerably related to male MMC coverage through the scholarly study duration, consistent with mathematical models suggesting that the HIV avoidance benefits of MMC to ladies accrue over longer periods."
The researchers compose that if similar associations are located somewhere else regarding community that is increasing and feminine ART coverage, this would support further scale-up of MMC and ART for HIV prevention in sub-Saharan Africa.
Article: Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda, Xiangrong Kong, PhD; Godfrey Kigozi, MB, ChB, PhD; Joseph Ssekasanvu, MS; Fred Nalugoda, PhD; Gertrude Nakigozi, MD, MPH; Anthony Ndyanabo, MSc; Tom Lutalo, MS; Steven J. Reynolds, MD, MPH; Robert Ssekubugu, MHS; Joseph Kagaayi, MB, ChB, PhD; Eva Bugos, BS; Larry W. Chang, MD, MPH; Pilgrim Nanlesta, PhD; Grabowski Mary, PhD; Amanda Berman, MSPH, MPhil; Thomas C. Quinn, MD; David Serwadda, MB, ChB, MMed, MPH; Maria J. Wawer, MD, MSH; Ronald H. Gray, MD, MSc, JAMA, doi:10.1001/jama.2016.7292, posted 12 2016 july.
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