scholarly journals Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda

2020 ◽  
Author(s):  
Gideon Loevinsohn ◽  
Godfrey Kigozi ◽  
Joseph Kagaayi ◽  
Maria J Wawer ◽  
Fred Nalugoda ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Prevention ◽  
The United States ◽  
Sub Saharan Africa ◽  
Human Immunodeficiency Virus Prevention ◽  
Voluntary Medical Male Circumcision ◽  
Hiv Incidence ◽  
Medical Male Circumcision ◽  
Immunodeficiency Virus ◽  
Hiv Acquisition

Abstract Background The efficacy of voluntary male medical circumcision (VMMC) for human immunodeficiency virus (HIV) prevention in men was demonstrated in 3 randomized trials. This led to the adoption of VMMC as an integral component of the United States 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 was 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 vs uncircumcised men. Results A total of 3916 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 (interquartile range [IQR], 21–35 years) to 22 years (IQR, 18–29 years) (P for trend < .001). HIV incidence was 0.40/100 PY (20/4992.8 PY) among newly circumcised men and 0.98/100 PY (118/12 095.1 PY) among uncircumcised men with an adjusted IRR of 0.47 (95% confidence interval, .28–.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.

scholarly journals Targeted Pregnancy and Human Immunodeficiency Virus Prevention Risk-Reduction Counseling for Young Women: Lessons Learned from Biomedical Prevention Trials

2018 ◽  
Vol 218 (11) ◽  
pp. 1759-1766 ◽  
Author(s):  
Gita Ramjee ◽  
Reshmi Dassaye ◽  
Tarylee Reddy ◽  
Handan Wand
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Hiv Prevention ◽  
Pregnant Women ◽  
Young Women ◽  
Cox Regression ◽  
Human Immunodeficiency Virus Prevention ◽  
Immunodeficiency Virus ◽  
Prevention Trials ◽  
Hiv Acquisition

Abstract Background Women enrolled in human immunodeficiency virus (HIV) prevention efficacy trials receive counseling on prevention of HIV, sexually transmitted infections (STIs), and pregnancy during every visit. Incident pregnancy has an impact on efficacy outcomes. Incidence rates of pregnancy and HIV/STIs among women who became pregnant and associated risk factors were assessed. Methods Data from 9165 women participating in HIV prevention trials in KwaZulu-Natal, South Africa from 2002–2012 were combined. Demographic and behavioral predictors of incidence pregnancy and incidence HIV and STIs were determined using Cox regression models. Results Overall pregnancy incidence was 9.6 per 100 person-year (py) (95% confidence interval [Cl], 9.1–10.3). Human immunodeficiency virus incidence among pregnant women was 5.93 per 100 py (95% Cl, 4.73–7.44). Incidence of STIs among pregnant women for Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum (syphilis) were 10.87, 7.42, 3.92, and 1.43 per 100 py, respectively. In the adjusted analyses, we observed overlapping risk factors for HIV acquisition during pregnancy, ie, young age, not married/not cohabitating, and low parity. The risk of pregnancy and HIV acquisition is more than 3 times higher among young women (<20 years of age). Conclusions We identified overlapping risk factors for pregnancy and HIV incidence, suggesting an urgent need for appropriate, targeted, individual-centred counseling for women participating in HIV prevention trials.

scholarly journals Use of Intrauterine Devices and Risk of Human Immunodeficiency Virus Acquisition Among Insured Women in the United States

2019 ◽  
Vol 70 (10) ◽  
pp. 2221-2223
Author(s):  
Julia L Marcus ◽  
Jonathan M Snowden ◽  
Mara E Murray Horwitz ◽  
Sengwee Toh ◽  
Casie Horgan ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Intrauterine Device ◽  
The United States ◽  
Hiv Diagnosis ◽  
Health Insurance Data ◽  
Virus Acquisition ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Hiv Acquisition

Abstract Concerns have been raised about progestin-containing contraceptives and the risk of human immunodeficiency virus (HIV) acquisition. Based on health insurance data from women in the United States with intrauterine device (IUD) insertions during 2011–2018, there was no increased risk of incident HIV diagnosis for levonorgestrel-releasing IUDs versus copper IUDs.

scholarly journals Ending the Human Immunodeficiency Virus Pandemic: Optimizing the Prevention and Treatment Toolkits

2019 ◽  
Vol 69 (12) ◽  
pp. 2212-2217 ◽  
Author(s):  
Robert W Eisinger ◽  
Gregory K Folkers ◽  
Anthony S Fauci
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Prevention ◽  
The United States ◽  
Risk Of Infection ◽  
The Past ◽  
Effective Interventions ◽  
Incidence And Mortality ◽  
Immunodeficiency Virus ◽  
Prevention And Treatment

Abstract Unprecedented basic and clinical biomedical research advances over the past 4 decades have led to the development of “toolkits” of highly effective interventions for preventing and treating human immunodeficiency virus (HIV). Despite many successes in decreasing the incidence and mortality of HIV, major challenges remain in the goal of ending the HIV pandemic in the United States and globally. Overcoming these challenges will require optimization of the implementation of existing interventions for HIV prevention and treatment together with the continued development of new and innovative approaches that can be readily utilized by individuals with HIV and those at risk of infection.

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