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Quantitative assessment of the role of male circumcision in HIV epidemiology at the population level.
Epidemics. 2009 Sep; 1(3):139-52.E

Abstract

OBJECTIVE

Three recent randomized trials have shown that male circumcision (circumcision) reduces HIV incidence in heterosexual men by about 60%. Mathematical models are needed to assess the historical role of circumcision in the observed disparate levels of prevalence in sub-Saharan Africa and to translate these findings into estimates of the population-level impact of circumcision on HIV prevalence.

METHODS AND FINDINGS

A deterministic compartmental model of HIV dynamics with circumcision was parameterized by empirical data from the Rakai, Masaka, and Four-City studies. Circumcision was found to account for about two-thirds of the differential HIV prevalence between West Africa and East and Southern Africa. We found that in Kisumu, Kenya, and in Rakai, Uganda, universal circumcision implemented in 2008 would reduce HIV prevalence by 19% and 14%, respectively, by 2020. In Kisumu, a setting with high HIV prevalence, about 6 circumcisions would be needed for each infection averted while in Rakai, 11 circumcisions would be needed. Females will also benefit from circumcision with a substantial reduction in prevalence of about 8% in Kisumu and 4% in Rakai within a few years of universal circumcision. The beneficial impact of circumcision for both males and females will not be undermined by risk behavior compensation unless the increase in risk behavior is in excess of 30%. The effectiveness of circumcision as an intervention is maximized by universal circumcision within 2-3 years.

CONCLUSIONS

In West Africa, circumcision may have "quarantined" the spread of HIV by limiting sustainable transmission to within high risk groups and bridge populations. Our findings indicate that circumcision is an effective intervention in both high and intermediate HIV prevalence settings. Circumcision coverage should be expanded as soon as possible to optimize the epidemiological impact.

Authors+Show Affiliations

Vaccine and Infectious Disease Institute, Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, USA. ralsalla@scharp.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21352761

Citation

Alsallaq, Ramzi A., et al. "Quantitative Assessment of the Role of Male Circumcision in HIV Epidemiology at the Population Level." Epidemics, vol. 1, no. 3, 2009, pp. 139-52.
Alsallaq RA, Cash B, Weiss HA, et al. Quantitative assessment of the role of male circumcision in HIV epidemiology at the population level. Epidemics. 2009;1(3):139-52.
Alsallaq, R. A., Cash, B., Weiss, H. A., Longini, I. M., Omer, S. B., Wawer, M. J., Gray, R. H., & Abu-Raddad, L. J. (2009). Quantitative assessment of the role of male circumcision in HIV epidemiology at the population level. Epidemics, 1(3), 139-52. https://doi.org/10.1016/j.epidem.2009.08.001
Alsallaq RA, et al. Quantitative Assessment of the Role of Male Circumcision in HIV Epidemiology at the Population Level. Epidemics. 2009;1(3):139-52. PubMed PMID: 21352761.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quantitative assessment of the role of male circumcision in HIV epidemiology at the population level. AU - Alsallaq,Ramzi A, AU - Cash,Brianna, AU - Weiss,Helen A, AU - Longini,Ira M,Jr AU - Omer,Saad B, AU - Wawer,Maria J, AU - Gray,Ronald H, AU - Abu-Raddad,Laith J, Y1 - 2009/08/20/ PY - 2008/08/13/received PY - 2009/07/21/revised PY - 2009/08/12/accepted PY - 2011/3/1/entrez PY - 2009/9/1/pubmed PY - 2011/11/5/medline SP - 139 EP - 52 JF - Epidemics JO - Epidemics VL - 1 IS - 3 N2 - OBJECTIVE: Three recent randomized trials have shown that male circumcision (circumcision) reduces HIV incidence in heterosexual men by about 60%. Mathematical models are needed to assess the historical role of circumcision in the observed disparate levels of prevalence in sub-Saharan Africa and to translate these findings into estimates of the population-level impact of circumcision on HIV prevalence. METHODS AND FINDINGS: A deterministic compartmental model of HIV dynamics with circumcision was parameterized by empirical data from the Rakai, Masaka, and Four-City studies. Circumcision was found to account for about two-thirds of the differential HIV prevalence between West Africa and East and Southern Africa. We found that in Kisumu, Kenya, and in Rakai, Uganda, universal circumcision implemented in 2008 would reduce HIV prevalence by 19% and 14%, respectively, by 2020. In Kisumu, a setting with high HIV prevalence, about 6 circumcisions would be needed for each infection averted while in Rakai, 11 circumcisions would be needed. Females will also benefit from circumcision with a substantial reduction in prevalence of about 8% in Kisumu and 4% in Rakai within a few years of universal circumcision. The beneficial impact of circumcision for both males and females will not be undermined by risk behavior compensation unless the increase in risk behavior is in excess of 30%. The effectiveness of circumcision as an intervention is maximized by universal circumcision within 2-3 years. CONCLUSIONS: In West Africa, circumcision may have "quarantined" the spread of HIV by limiting sustainable transmission to within high risk groups and bridge populations. Our findings indicate that circumcision is an effective intervention in both high and intermediate HIV prevalence settings. Circumcision coverage should be expanded as soon as possible to optimize the epidemiological impact. SN - 1878-0067 UR - https://www.unboundmedicine.com/medline/citation/21352761/Quantitative_assessment_of_the_role_of_male_circumcision_in_HIV_epidemiology_at_the_population_level_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1755-4365(09)00040-1 DB - PRIME DP - Unbound Medicine ER -