Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa.

Autor: Cork MA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Wilson KF; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Perkins S; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Collison ML; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Deshpande A; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Eaton JW; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.; Department of Infectious Disease Epidemiology, Imperial College London, London, UK., Earl L; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Haeuser E; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Justman JE; ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Kinyoki DK; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Mayala BK; DHS program, ICF International, Rockville, MD, USA., Mosser JF; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA., Murray CJL; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA., Nkengasong JN; Africa Centres for Disease Control and Prevention, African Union, Addis Ababa, Ethiopia., Piot P; London School of Hygiene & Tropical Medicine, London, UK., Sartorius B; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.; London School of Hygiene & Tropical Medicine, London, UK., Schaeffer LE; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Serfes AL; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Sligar A; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Steuben KM; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Tanser FC; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.; Africa Health Research Institute, KwaZulu-Natal, South Africa.; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.; Research Department of Infection & Population Health, University College London, London, UK., VanderHeide JD; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Yang M; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Wabiri N; HIV/AIDS, STIs & TB Research Programme, Human Sciences Research Council, Pretoria, South Africa., Hay SI; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA., Dwyer-Lindgren L; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. ladwyer@uw.edu.; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA. ladwyer@uw.edu.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2020 Jul 07; Vol. 18 (1), pp. 189. Date of Electronic Publication: 2020 Jul 07.
DOI: 10.1186/s12916-020-01635-5
Abstrakt: Background: HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50-60%. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15-49. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence.
Methods: We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15-49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units.
Results: We found striking within-country and between-country variation in MC prevalence; most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas.
Conclusions: Despite MC prevalence increases in all priority countries since the onset of VMMC campaigns in 2008, MC prevalence remains below the 80% coverage target in most subnational areas and is highly variable. These mapped results provide an actionable tool for understanding local needs and informing VMMC interventions for maximum impact in the continued effort towards ending the HIV epidemic in sub-Saharan Africa.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje