Commentary: Disease modelling to inform policy on male circumcision for HIV prevention
Identifieur interne : 001431 ( Istex/Corpus ); précédent : 001430; suivant : 001432Commentary: Disease modelling to inform policy on male circumcision for HIV prevention
Auteurs : Ronald H. Gray ; Maria J. Wawer ; Godfrey Kigozi ; David SerwaddaSource :
- International Journal of Epidemiology [ 0300-5771 ] ; 2008-12.
Url:
DOI: 10.1093/ije/dyn081
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Wawer</name><affiliation><mods:affiliation>Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</mods:affiliation></affiliation></author><author><name sortKey="Kigozi, Godfrey" sort="Kigozi, Godfrey" uniqKey="Kigozi G" first="Godfrey" last="Kigozi">Godfrey Kigozi</name><affiliation><mods:affiliation>Rakai Health Sciences Program, Entebbe, Uganda.</mods:affiliation></affiliation></author><author><name sortKey="Serwadda, David" sort="Serwadda, David" uniqKey="Serwadda D" first="David" last="Serwadda">David Serwadda</name><affiliation><mods:affiliation>School of Public Health, Makerere University, Kampala, Uganda.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1093/ije/dyn081</idno><idno type="url">https://api.istex.fr/document/3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001431</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001431</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Commentary: Disease modelling to inform policy on male circumcision for HIV prevention</title><author><name sortKey="Gray, Ronald H" sort="Gray, Ronald H" uniqKey="Gray R" first="Ronald H" last="Gray">Ronald H. Gray</name><affiliation><mods:affiliation>Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rgray@jhsph.edu</mods:affiliation></affiliation><affiliation><mods:affiliation></mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: rgray@jhsph.edu</mods:affiliation></affiliation></author><author><name sortKey="Wawer, Maria J" sort="Wawer, Maria J" uniqKey="Wawer M" first="Maria J" last="Wawer">Maria J. 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all rights reserved.</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</p></availability><date>2008-05-09</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Commentary: Disease modelling to inform policy on male circumcision for HIV prevention</title><author xml:id="author-0000" corresp="yes"><persName><forename type="first">Ronald H</forename><surname>Gray</surname></persName><email>rgray@jhsph.edu</email><email>rgray@jhsph.edu</email><affiliation>Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</affiliation><affiliation></affiliation></author><author xml:id="author-0001"><persName><forename type="first">Maria J</forename><surname>Wawer</surname></persName><affiliation>Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Godfrey</forename><surname>Kigozi</surname></persName><affiliation>Rakai Health Sciences Program, Entebbe, Uganda.</affiliation></author><author xml:id="author-0003"><persName><forename type="first">David</forename><surname>Serwadda</surname></persName><affiliation>School of Public Health, Makerere University, Kampala, Uganda.</affiliation></author><idno type="istex">3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A</idno><idno type="ark">ark:/67375/HXZ-M7C77PXH-P</idno><idno type="DOI">10.1093/ije/dyn081</idno><idno type="article-id">dyn081</idno><idno type="Related-article-href">10.1093/ije/dyn038</idno><idno type="related-article-ID">RA1</idno></analytic><monogr><title level="j">International Journal of Epidemiology</title><idno type="pISSN">0300-5771</idno><idno type="eISSN">1464-3685</idno><idno type="publisher-id">ije</idno><idno type="PublisherID-hwp">intjepid</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-12"></date><biblScope unit="volume">37</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="1253">1253</biblScope><biblScope unit="page" to="1254">1254</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2008-05-09</date></creation><textClass><keywords scheme="Journal Subject"><list><head></head><item><term>Special Theme: HIV Infection</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-05-09">Created</change><change when="2008-12">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
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<article-title>Commentary: Disease modelling to inform policy on male circumcision for HIV prevention</article-title>
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<name><surname>Gray</surname><given-names>Ronald H</given-names></name>
<xref ref-type="aff" rid="AFF1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="COR1">*</xref>
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<contrib contrib-type="author">
<name><surname>Wawer</surname><given-names>Maria J</given-names></name>
<xref ref-type="aff" rid="AFF1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Kigozi</surname><given-names>Godfrey</given-names></name>
<xref ref-type="aff" rid="AFF2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Serwadda</surname><given-names>David</given-names></name>
<xref ref-type="aff" rid="AFF3"><sup>3</sup></xref>
</contrib>
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<aff id="AFF1"><sup>1</sup> Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</aff>
<aff id="AFF2"><sup>2</sup> Rakai Health Sciences Program, Entebbe, Uganda.</aff>
<aff id="AFF3"><sup>3</sup> School of Public Health, Makerere University, Kampala, Uganda.</aff>
<author-notes>
<corresp id="COR1">* Corresponding author. E-mail: <email>rgray@jhsph.edu</email></corresp>
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<p><related-article related-article-type="in-this-issue" xlink:href="10.1093/ije/dyn038" id="RA1" ext-link-type="highwire"></related-article></p>
<p>The findings from three randomized trials<xref ref-type="bibr" rid="B1 B2 B3"><sup>1–3</sup></xref> and multiple observational studies<xref ref-type="bibr" rid="B4"><sup>4</sup></xref> that male circumcision prevents HIV acquisition in men has been welcomed as an historic opportunity to control the HIV epidemic, particularly in sub-Saharan Africa.<xref ref-type="bibr" rid="B5"><sup>5</sup></xref> However, the challenges are daunting because we have never attempted to use surgery as a means of controlling an infectious disease, the African health infrastructure is weak and trained personnel required to provide circumcision surgery on a massive scale are limited. Therefore, modelling the impact of circumcision on the future course of the HIV epidemic is needed to persuade health authorities and donors to invest resources in this unprecedented initiative.</p>
<p>The paper by Londish and Murray in this volume<xref ref-type="bibr" rid="B6"><sup>6</sup></xref> adds to the growing body of models, all of which suggest that circumcision has the potential to abate but not abolish the African HIV epidemic over a period of 10-20 years.<xref ref-type="bibr" rid="B7 B8 B9 B10"><sup>7–10</sup></xref> A variety of model projections were reviewed at a recent Joint United Nations Programme on AIDS (UNAIDS) meeting at Imperial College, London (March 5–6, 2008). A report will be forthcoming. The models have varied in their assumptions and structures, and in the endpoints used (e.g. HIV prevalence or incidence over time, HIV infections or AIDS deaths prevented, the number of surgeries needed to avert one HIV infection and the costs per infection averted). Irrespective of these differences in modelling methods and outputs, the direct biological effect of circumcision on reducing HIV acquisition in men by ∼60%, and the secondary protection afforded to women via reduced exposures to HIV infected men, are so overwhelming that, under most plausible scenarios, the impact of circumcision on the African HIV epidemic is clear and substantial. The impact of circumcision will likely be greatest in settings, such as those in southern Africa, where HIV incidence is high and the prevalence of circumcision is low.</p>
<p>The circumcision trials provide an estimate on the numbers needed to treat per HIV infection over a short period of two years. However, since the efficacy of circumcision is likely to be life long, models can estimate the number of surgeries needed to prevent one HIV infection over a period of 10–20 years. In most sub-Saharan African settings, the number of surgeries per HIV infection averted over a decade ranges from 5–15, depending on male HIV incidence. This makes circumcision a highly cost effective intervention, particularly when costs are discounted by savings for future antiretroviral care due to prevention of HIV acquisition.</p>
<p>Other policy relevant questions addressed by modelling include whether to provide services to all men or to focus on specific segments of the population such as limited age groups or subgroups with higher sexual risk behaviours. Thus, as suggested by Londish and Murray, priority might be given to men aged 20–34 among whom incidence is generally greatest in Africa, and because such men often have relationships with younger female partners, the derivative benefits to women are likely to be maximized. Similarly, a focus on high risk core groups such as STD clinic attendees or clients of commercial sex workers might provide greater benefit. However, there are practical limitations to such strategies. First, HIV prevalence will be high in such high incidence subgroups, and since circumcision of HIV-infected men does not appear to directly benefit women,<xref ref-type="bibr" rid="B11"><sup>11</sup></xref> the impact of the program will be diluted and there would be substantial number of surgeries in already HIV infected men who may infect their female partners if intercourse is resumed before full wound healing is complete.<xref ref-type="bibr" rid="B11"><sup>11</sup></xref> Second, such ‘targeting’ could exclude large segments of the male population who, given the belief that circumcision is protective, might seek services from unsafe sources. Therefore, although models predict greater impact from targeting specific adult age or risk groups, this may be of limited practical programmatic value.</p>
<p>Models can also address the question of whether to devote resources to surgery in adolescents and adults, or to infant circumcision. Again, the results are clear. Adolescent and adult surgery will reduce HIV over 10–20 years, whereas with infant circumcision, HIV impact will be delayed for more than 20 years due to delayed onset of sexual activity. Similarly, models can provide guidance for the speed of program scale up. Rapid achievement of high circumcision coverage will maximize impact by more rapidly preventing new HIV infections in the population.</p>
<p>In summary, modelling the effectiveness of circumcision for HIV prevention can be an important tool for policy and planning. The only remaining question is whether policy makers will use this information in their decision making, whether they will devote resources to this initiative, and whether programs can be brought to scale in a timely manner.</p>
</body>
<back>
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</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Commentary: Disease modelling to inform policy on male circumcision for HIV prevention</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Commentary: Disease modelling to inform policy on male circumcision for HIV prevention</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Ronald H</namePart><namePart type="family">Gray</namePart><affiliation>Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</affiliation><affiliation>E-mail: rgray@jhsph.edu</affiliation><affiliation></affiliation><affiliation>E-mail: rgray@jhsph.edu</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Maria J</namePart><namePart type="family">Wawer</namePart><affiliation>Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Godfrey</namePart><namePart type="family">Kigozi</namePart><affiliation>Rakai Health Sciences Program, Entebbe, Uganda.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David</namePart><namePart type="family">Serwadda</namePart><affiliation>School of Public Health, Makerere University, Kampala, Uganda.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2008-12</dateIssued><dateCreated encoding="w3cdtf">2008-05-09</dateCreated><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><relatedItem type="host"><titleInfo><title>International Journal of Epidemiology</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><topic>Special Theme: HIV Infection</topic></subject><identifier type="ISSN">0300-5771</identifier><identifier type="eISSN">1464-3685</identifier><identifier type="PublisherID">ije</identifier><identifier type="PublisherID-hwp">intjepid</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>37</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>1253</start><end>1254</end></extent></part></relatedItem><identifier type="istex">3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A</identifier><identifier type="DOI">10.1093/ije/dyn081</identifier><identifier type="ArticleID">dyn081</identifier><identifier type="Related-article-href">10.1093/ije/dyn038</identifier><identifier type="related-article-ID">RA1</identifier><accessCondition type="use and reproduction" contentType="copyright">Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource><recordOrigin>Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A/metadata/json</uri></json:item></metadata><covers><json:item><extension>tiff</extension><original>true</original><mimetype>image/tiff</mimetype><uri>https://api.istex.fr/document/3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A/covers/tiff</uri></json:item></covers><annexes><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/3EA0D0A0E9B323A23DC3EB20FE38482CCEC44E5A/annexes/pdf</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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