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
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:
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%)
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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