6th IAS Conference On HIV Pathogenesis, Treatment and Prevention


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WELBC02 - Oral Abstract Session

Effect of the Orange Farm (South Africa) male circumcision roll-out (ANRS-12126) on the spread of HIV

Presented by Bertran Auvert (France).

B. Auvert1, D. Taljaard2, D. Rech2, P. Lissouba3, B. Singh4, D. Shabangu2, C. Nhlapo5, J. Otchere-Darko2, T. Mashigo2, G. Phatedi2, R. Taljaard2, M. Tsepe2, M. Chakela2, A. Mkhwanazi2, P. Ntshangase2, S. Billy5, D. Lewis4

1Univeristy of Versailles, Versailles, France, 2Progressus, Johannesburg, South Africa, 3Inserm 1018, Villejuif, France, 4NICD-NHLS, Johannesburg, South Africa, 5SFH, Johannesburg, South Africa

Background: The real-world effect of the roll-out of medical male circumcision (MMC) in Southern and Eastern Africa on the HIV epidemic is unknown. Three years after the beginning of the Orange Farm (South Africa) MMC roll-out (ANRS-12126), the project´s impact on the spread of HIV in the community was assessed.
Methods: Two cross-sectional surveys were conducted, one in 2007, before the beginning of the project, and one in late 2010. The response rates exceeded 80%. Male residents aged 15 to 49 (1,198 in 2007 and 1,195 in 2010) were randomly sampled, interviewed, counseled and tested for HIV. The 2010 HIV-positive samples were tested using the Calypte HIV-1 BED Incidence EIA (BED) assay with corrections for misclassifications. HIV prevalence and incidence among circumcised and uncircumcised men from the 2010 survey were compared using a weighted propensity score analysis based on a Poisson regression model.
Results: MMC prevalence increased from 15.6% to 49.4% among participants aged 15 to 49. No effect of MMC status on sexual behavior was detected. In the 15 to 49 age group, HIV prevalence was 20.0% (117/586) among uncircumcised men and 6.2% (36/582) among circumcised men (P< 0.001). The adjusted prevalence ratio was 0.45 (95%CI: 0.30−0.63). In the 15 to 34 age group, the corrected HIV incidence rate was 2.86 /100 person-year among uncircumcised men and 0.42 /100 person-year among circumcised men. The adjusted incidence rate ratio was 0.20 (95%CI: 0.00−0.55). Without the intervention, if no men were circumcised, HIV prevalence among all men aged 15 to 49 would have been 25.1% (95%CI: 13.1%−39.1%) higher, and HIV incidence among all men aged 15 to 34, 61.0% (95%CI: 23.0%−152%) higher.
Conclusion: This study shows for the first time that the roll-out of MMC in Southern and Eastern Africa, can, if successfully promoted, markedly decrease the spread of HIV in endemic communities.

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