TUAC0403 - Oral Abstract Session
Decrease of HIV prevalence over time among the male population of Orange Farm, South Africa, following a circumcision roll-out (ANRS-12126)
Presented by Bertran Auvert (France).
B. Auvert1, D. Taljaard2, R. Sitta3, D. Reach2, P. Lissouba3, J. Bouscaillou3, B. Singh4, D. Shabangu2, C. Nhlapo5, J. Otchere- Darko2, T. Mashigo2, R. Taljaard6, G. Phatedi2, M. Tsepe2, M. Chakela2, A. Mkhwanazi2, P. Ntshangase2, G. Peytavin7, S. Billy5, A. Puren4, D. Lewis4
1University of Versailles, Versailles, France, 2CHAPS, Johannesburg, South Africa, 3Inserm U1018-CESP, Villejuif, France, 4NICD-NHLS, Johannesburg, South Africa, 5SFH, Johannesburg, South Africa, 6Progressus, Johannesburg, South Africa, 7Hopital Bichat - Claude-Bernard, Paris, France
Background: The effect of the
roll-out of voluntary medical male circumcision (VMMC) in Southern and Eastern Africa on HIV
prevalence is unknown. Three years after the beginning of the Orange Farm (South
Africa) VMMC roll-out
(ANRS-12126), the project´s impact on HIV prevalence over time was assessed.
Methods: Two cross-sectional
surveys were conducted, one in 2007-2008 (n=1971), before the beginning of the
roll-out, and one in 2010-2011 (n=3268). The response rates exceeded 80%. Male
residents aged 15 to 49 were randomly
sampled, interviewed, assessed for circumcision status, counselled and tested
for HIV. Blood samples were tested for HIV and for recent HIV infection using
the BED assay. Prevalence ratios (PR) were calculated using multivariate (aPR)
and propensity score weighted (wPR) Poisson regression models to assess the
association of HIV prevalence and recent HIV infections with time and
circumcision status. Covariates comprised age group, ethnic group, religion, having
children, alcohol consumption, education level, age at first sexual
intercourse, marital status and occupation.
Results: In three years, male
circumcision prevalence standardized on age increased from 17.0% to 53.9%. In
the 2007-2008 and 2010-2011 surveys, the propensity weighted effect of
circumcision status on HIV prevalence was wPR=0.37 (95%CI: 0.19−0.58) and wPR=0.48 (95%CI: 0.35−0.65), respectively. HIV prevalence standardized on age decreased
from 12.5% to 9.3%, aPR= 0.74 (95%CI: 0.60−0.91), among participants aged 15 to 49, and from 6.2% to 4.2%, aPR= 0.64 (95%CI: 0.49−0.85), among participants aged 15 to 29. Propensity analyses showed that the intervention avoided
536 (95%CI: 135 −1318) HIV infections in
2011 among the 52,000 adult men living in Orange Farm.
Conclusions: This study shows for the first time that the roll-out of VMMC in Africa can, if
successfully promoted, lead to a decrease of HIV prevalence over time,
detectable three years after its onset.
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