The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a post-trial follow up study in Rakai, Uganda

Ron Gray, Godfrey Kigozi, Xiangrong Kong, Victor Ssempiija, Frederick Makumbi, Stephen Wattya, David Serwadda, Fred Nalugoda, Nelson K. Sewenkambo, Maria J. Wawer

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The efficacy of male circumcision (MC) for HIV prevention over two years has been demonstrated in three randomized trials, but the longer-term effectiveness of MC is unknown. METHODS: We conducted a randomized trial of MC in 4996 HIV-negative men aged 15-49 in Rakai Uganda. Following trial closure we offered MC to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years (py) was assessed in an as-treated analysis, and the effectiveness of MC was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first post-trial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation. RESULTS: By Dec 15, 2010, 78.4% of uncircumcised trial participants accepted MC following trial closure. During post-trial surveillance, overall HIV incidence was 0.50/100 py in circumcised men and 1.93/100 py in uncircumcised men (adjusted effectiveness 73% (95%CI 55-84%). In control arm participants, post-trial HIV incidence was 0.54/100 py in circumcised and 1.71/100 py in uncircumcised men (adjusted effectiveness 67% (95%CI 38-83%). There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting MC and those remaining uncircumcised. CONCLUSIONS: High effectiveness of MC for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with post-trial MC acceptance.

Original languageEnglish (US)
JournalAIDS
DOIs
StateAccepted/In press - Dec 29 2011

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Male Circumcision
Uganda
Risk-Taking
HIV
Sexual Behavior
Incidence
Behavior Control
Proportional Hazards Models

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology
  • Immunology and Allergy

Cite this

The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a post-trial follow up study in Rakai, Uganda. / Gray, Ron; Kigozi, Godfrey; Kong, Xiangrong; Ssempiija, Victor; Makumbi, Frederick; Wattya, Stephen; Serwadda, David; Nalugoda, Fred; Sewenkambo, Nelson K.; Wawer, Maria J.

In: AIDS, 29.12.2011.

Research output: Contribution to journalArticle

Gray, Ron ; Kigozi, Godfrey ; Kong, Xiangrong ; Ssempiija, Victor ; Makumbi, Frederick ; Wattya, Stephen ; Serwadda, David ; Nalugoda, Fred ; Sewenkambo, Nelson K. ; Wawer, Maria J. / The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a post-trial follow up study in Rakai, Uganda. In: AIDS. 2011.
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abstract = "BACKGROUND: The efficacy of male circumcision (MC) for HIV prevention over two years has been demonstrated in three randomized trials, but the longer-term effectiveness of MC is unknown. METHODS: We conducted a randomized trial of MC in 4996 HIV-negative men aged 15-49 in Rakai Uganda. Following trial closure we offered MC to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years (py) was assessed in an as-treated analysis, and the effectiveness of MC was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first post-trial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation. RESULTS: By Dec 15, 2010, 78.4{\%} of uncircumcised trial participants accepted MC following trial closure. During post-trial surveillance, overall HIV incidence was 0.50/100 py in circumcised men and 1.93/100 py in uncircumcised men (adjusted effectiveness 73{\%} (95{\%}CI 55-84{\%}). In control arm participants, post-trial HIV incidence was 0.54/100 py in circumcised and 1.71/100 py in uncircumcised men (adjusted effectiveness 67{\%} (95{\%}CI 38-83{\%}). There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting MC and those remaining uncircumcised. CONCLUSIONS: High effectiveness of MC for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with post-trial MC acceptance.",
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AU - Gray, Ron

AU - Kigozi, Godfrey

AU - Kong, Xiangrong

AU - Ssempiija, Victor

AU - Makumbi, Frederick

AU - Wattya, Stephen

AU - Serwadda, David

AU - Nalugoda, Fred

AU - Sewenkambo, Nelson K.

AU - Wawer, Maria J.

PY - 2011/12/29

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N2 - BACKGROUND: The efficacy of male circumcision (MC) for HIV prevention over two years has been demonstrated in three randomized trials, but the longer-term effectiveness of MC is unknown. METHODS: We conducted a randomized trial of MC in 4996 HIV-negative men aged 15-49 in Rakai Uganda. Following trial closure we offered MC to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years (py) was assessed in an as-treated analysis, and the effectiveness of MC was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first post-trial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation. RESULTS: By Dec 15, 2010, 78.4% of uncircumcised trial participants accepted MC following trial closure. During post-trial surveillance, overall HIV incidence was 0.50/100 py in circumcised men and 1.93/100 py in uncircumcised men (adjusted effectiveness 73% (95%CI 55-84%). In control arm participants, post-trial HIV incidence was 0.54/100 py in circumcised and 1.71/100 py in uncircumcised men (adjusted effectiveness 67% (95%CI 38-83%). There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting MC and those remaining uncircumcised. CONCLUSIONS: High effectiveness of MC for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with post-trial MC acceptance.

AB - BACKGROUND: The efficacy of male circumcision (MC) for HIV prevention over two years has been demonstrated in three randomized trials, but the longer-term effectiveness of MC is unknown. METHODS: We conducted a randomized trial of MC in 4996 HIV-negative men aged 15-49 in Rakai Uganda. Following trial closure we offered MC to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years (py) was assessed in an as-treated analysis, and the effectiveness of MC was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first post-trial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation. RESULTS: By Dec 15, 2010, 78.4% of uncircumcised trial participants accepted MC following trial closure. During post-trial surveillance, overall HIV incidence was 0.50/100 py in circumcised men and 1.93/100 py in uncircumcised men (adjusted effectiveness 73% (95%CI 55-84%). In control arm participants, post-trial HIV incidence was 0.54/100 py in circumcised and 1.71/100 py in uncircumcised men (adjusted effectiveness 67% (95%CI 38-83%). There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting MC and those remaining uncircumcised. CONCLUSIONS: High effectiveness of MC for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with post-trial MC acceptance.

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