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

Gideon Loevinsohn; Godfrey Kigozi; Joseph Kagaayi; Maria J. Wawer; Fred Nalugoda; Larry W. Chang; Thomas C. Quinn; David Serwadda; Steven J. Reynolds; Lisa Nelson; Lisa Mills; Stella Alamo; Gertrude Nakigozi; Geoffrey Kabuye; Robert Ssekubugu; Aaron A.R. Tobian; Ronald H. Gray; M. Kathryn Grabowski; Dorean Nabukalu; Anthony Ndyanabo; Joseph Ssekasanvu; Hadijja Nakawooya; Jessica Nakukumba; Grace N. Kigozi; Betty S. Nantume; Nampijja Resty; Jedidah Kambasu; Margaret Nalugemwa; Regina Nakabuye; Lawrence Ssebanobe; Justine Nankinga; Adrian Kayiira; Gorreth Nanfuka; Ruth Ahimbisibwe; Stephen Tomusange; Ronald M. Galiwango; Sarah Kalibbali; Margaret Nakalanzi; Joseph Ouma Otobi; Denis Ankunda; Joseph Lister Ssembatya; John Baptist Ssemanda; Robert Kairania; Emmanuel Kato; Alice Kisakye; James Batte; James Ludigo; Abisagi Nampijja; Steven Watya; Kighoma Nehemia; Sr Margaret Anyokot; Joshua Mwinike; George Kibumba; Paschal Ssebowa; George Mondo; Francis Wasswa; Agnes Nantongo; Rebecca Kakembo; Josephine Galiwango; Geoffrey Ssemango; Andrew D. Redd; John Santelli; Caitlin E. Kennedy; Jennifer Wagman; Tom Lutalo; Fred Makumbi; Nelson K. Sewankambo; Oliver Laeyendecker

doi:10.1093/cid/ciaa1533

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

Gideon Loevinsohn, Godfrey Kigozi, Joseph Kagaayi, Maria J. Wawer, Fred Nalugoda, Larry W. Chang, Thomas C. Quinn, David Serwadda, Steven J. Reynolds, Lisa Nelson, Lisa Mills, Stella Alamo, Gertrude Nakigozi, Geoffrey Kabuye, Robert Ssekubugu, Aaron A.R. Tobian, Ronald H. Gray, M. Kathryn Grabowski, Dorean Nabukalu, Anthony NdyanaboJoseph Ssekasanvu, Hadijja Nakawooya, Jessica Nakukumba, Grace N. Kigozi, Betty S. Nantume, Nampijja Resty, Jedidah Kambasu, Margaret Nalugemwa, Regina Nakabuye, Lawrence Ssebanobe, Justine Nankinga, Adrian Kayiira, Gorreth Nanfuka, Ruth Ahimbisibwe, Stephen Tomusange, Ronald M. Galiwango, Sarah Kalibbali, Margaret Nakalanzi, Joseph Ouma Otobi, Denis Ankunda, Joseph Lister Ssembatya, John Baptist Ssemanda, Robert Kairania, Emmanuel Kato, Alice Kisakye, James Batte, James Ludigo, Abisagi Nampijja, Steven Watya, Kighoma Nehemia, Sr Margaret Anyokot, Joshua Mwinike, George Kibumba, Paschal Ssebowa, George Mondo, Francis Wasswa, Agnes Nantongo, Rebecca Kakembo, Josephine Galiwango, Geoffrey Ssemango, Andrew D. Redd, John Santelli, Caitlin E. Kennedy, Jennifer Wagman, Tom Lutalo, Fred Makumbi, Nelson K. Sewankambo, Oliver Laeyendecker

Mailman School of Public Health

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

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.

Original language	English
Pages (from-to)	E1946-E1953
Journal	Clinical Infectious Diseases
Volume	73
Issue number	7
DOIs	https://doi.org/10.1093/cid/ciaa1533
Publication status	Published - Oct 1 2021

Bibliographical note

Publisher Copyright:
© 2020 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

Funding

This work was supported by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID); the NIAID (grant numbers R01AI128779, R01AI110324, U01AI100031, U01AI075115, and K01AI125086-01); the National Institute of Mental Health (grant number R01MH107275); the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant numbers RO1HD070769 and R01HD050180); the Johns Hopkins University Center for AIDS Research (grant number P30AI094189); and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under the terms of NU2GGH000817.

Funders	Funder number
National Institute of Mental Health	R01MH107275
Centers for Disease Control and Prevention	NU2GGH000817
National Institute of Allergy and Infectious Diseases	U01AI100031, K01AI125086-01, R01AI128779, P30AI094189, R01AI110324, ZIAAI001040, U01AI075115
Division of Intramural Research, National Institute of Allergy and Infectious Diseases
Johns Hopkins University
U.S. President’s Emergency Plan for AIDS Relief
Eunice Kennedy Shriver National Institute of Child Health and Human Development	RO1HD070769, R01HD050180

ASJC Scopus Subject Areas

Microbiology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/cid/ciaa1533

Cite this

Loevinsohn, G., Kigozi, G., Kagaayi, J., Wawer, M. J., Nalugoda, F., Chang, L. W., Quinn, T. C., Serwadda, D., Reynolds, S. J., Nelson, L., Mills, L., Alamo, S., Nakigozi, G., Kabuye, G., Ssekubugu, R., Tobian, A. A. R., Gray, R. H., Grabowski, M. K., Nabukalu, D., ... Laeyendecker, O. (2021). Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda. Clinical Infectious Diseases, 73(7), E1946-E1953. https://doi.org/10.1093/cid/ciaa1533

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, Nabukalu, D, Ndyanabo, A, Ssekasanvu, J, Nakawooya, H, Nakukumba, J, Kigozi, GN, Nantume, BS, Resty, N, Kambasu, J, Nalugemwa, M, Nakabuye, R, Ssebanobe, L, Nankinga, J, Kayiira, A, Nanfuka, G, Ahimbisibwe, R, Tomusange, S, Galiwango, RM, Kalibbali, S, Nakalanzi, M, Otobi, JO, Ankunda, D, Ssembatya, JL, Ssemanda, JB, Kairania, R, Kato, E, Kisakye, A, Batte, J, Ludigo, J, Nampijja, A, Watya, S, Nehemia, K, Anyokot, SM, Mwinike, J, Kibumba, G, Ssebowa, P, Mondo, G, Wasswa, F, Nantongo, A, Kakembo, R, Galiwango, J, Ssemango, G, Redd, AD, Santelli, J, Kennedy, CE, Wagman, J, Lutalo, T, Makumbi, F, Sewankambo, NK & Laeyendecker, O 2021, 'Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda', Clinical Infectious Diseases, vol. 73, no. 7, pp. E1946-E1953. https://doi.org/10.1093/cid/ciaa1533

@article{3c0283d6092a4b7e8765fd1c1975dfea,

title = "Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda",

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.",

author = "Gideon Loevinsohn and Godfrey Kigozi and Joseph Kagaayi and Wawer, {Maria J.} and Fred Nalugoda and Chang, {Larry W.} and Quinn, {Thomas C.} and David Serwadda and Reynolds, {Steven J.} and Lisa Nelson and Lisa Mills and Stella Alamo and Gertrude Nakigozi and Geoffrey Kabuye and Robert Ssekubugu and Tobian, {Aaron A.R.} and Gray, {Ronald H.} and Grabowski, {M. Kathryn} and Dorean Nabukalu and Anthony Ndyanabo and Joseph Ssekasanvu and Hadijja Nakawooya and Jessica Nakukumba and Kigozi, {Grace N.} and Nantume, {Betty S.} and Nampijja Resty and Jedidah Kambasu and Margaret Nalugemwa and Regina Nakabuye and Lawrence Ssebanobe and Justine Nankinga and Adrian Kayiira and Gorreth Nanfuka and Ruth Ahimbisibwe and Stephen Tomusange and Galiwango, {Ronald M.} and Sarah Kalibbali and Margaret Nakalanzi and Otobi, {Joseph Ouma} and Denis Ankunda and Ssembatya, {Joseph Lister} and Ssemanda, {John Baptist} and Robert Kairania and Emmanuel Kato and Alice Kisakye and James Batte and James Ludigo and Abisagi Nampijja and Steven Watya and Kighoma Nehemia and Anyokot, {Sr Margaret} and Joshua Mwinike and George Kibumba and Paschal Ssebowa and George Mondo and Francis Wasswa and Agnes Nantongo and Rebecca Kakembo and Josephine Galiwango and Geoffrey Ssemango and Redd, {Andrew D.} and John Santelli and Kennedy, {Caitlin E.} and Jennifer Wagman and Tom Lutalo and Fred Makumbi and Sewankambo, {Nelson K.} and Oliver Laeyendecker",

year = "2021",

month = oct,

day = "1",

doi = "10.1093/cid/ciaa1533",

language = "English",

volume = "73",

pages = "E1946--E1953",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "7",

}

TY - JOUR

T1 - Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda

AU - Loevinsohn, Gideon

AU - Kigozi, Godfrey

AU - Kagaayi, Joseph

AU - Wawer, Maria J.

AU - Nalugoda, Fred

AU - Chang, Larry W.

AU - Quinn, Thomas C.

AU - Serwadda, David

AU - Reynolds, Steven J.

AU - Nelson, Lisa

AU - Mills, Lisa

AU - Alamo, Stella

AU - Nakigozi, Gertrude

AU - Kabuye, Geoffrey

AU - Ssekubugu, Robert

AU - Tobian, Aaron A.R.

AU - Gray, Ronald H.

AU - Grabowski, M. Kathryn

AU - Nabukalu, Dorean

AU - Ndyanabo, Anthony

AU - Ssekasanvu, Joseph

AU - Nakawooya, Hadijja

AU - Nakukumba, Jessica

AU - Kigozi, Grace N.

AU - Nantume, Betty S.

AU - Resty, Nampijja

AU - Kambasu, Jedidah

AU - Nalugemwa, Margaret

AU - Nakabuye, Regina

AU - Ssebanobe, Lawrence

AU - Nankinga, Justine

AU - Kayiira, Adrian

AU - Nanfuka, Gorreth

AU - Ahimbisibwe, Ruth

AU - Tomusange, Stephen

AU - Galiwango, Ronald M.

AU - Kalibbali, Sarah

AU - Nakalanzi, Margaret

AU - Otobi, Joseph Ouma

AU - Ankunda, Denis

AU - Ssembatya, Joseph Lister

AU - Ssemanda, John Baptist

AU - Kairania, Robert

AU - Kato, Emmanuel

AU - Kisakye, Alice

AU - Batte, James

AU - Ludigo, James

AU - Nampijja, Abisagi

AU - Watya, Steven

AU - Nehemia, Kighoma

AU - Anyokot, Sr Margaret

AU - Mwinike, Joshua

AU - Kibumba, George

AU - Ssebowa, Paschal

AU - Mondo, George

AU - Wasswa, Francis

AU - Nantongo, Agnes

AU - Kakembo, Rebecca

AU - Galiwango, Josephine

AU - Ssemango, Geoffrey

AU - Redd, Andrew D.

AU - Santelli, John

AU - Kennedy, Caitlin E.

AU - Wagman, Jennifer

AU - Lutalo, Tom

AU - Makumbi, Fred

AU - Sewankambo, Nelson K.

AU - Laeyendecker, Oliver

PY - 2021/10/1

Y1 - 2021/10/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85114464821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85114464821&partnerID=8YFLogxK

U2 - 10.1093/cid/ciaa1533

DO - 10.1093/cid/ciaa1533

M3 - Article

C2 - 33043978

AN - SCOPUS:85114464821

SN - 1058-4838

VL - 73

SP - E1946-E1953

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 7

ER -

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

Abstract

Bibliographical note

Funding

ASJC Scopus Subject Areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this