Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis
Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis
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DOI：
10.1371/journal.pone.0170641
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发表时间：
2017-01-24
期刊：
影响因子：
3.7
通讯作者：
Abu-Raddad, Laith J.
中科院分区：
文献类型：
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作者：
Awad, Susanne F.;Sgaier, Sema K.;Abu-Raddad, Laith J.
自愿医学男性包皮环切（VMMC）项目中hiv阳性男性包容性的流行病学和规划意义尚不确定。我们以赞比亚为例对这些影响进行了建模。方法和发现我们使用年龄结构数学（ASM）模型来评估，在中期（2010-2025年），不同比例的HIV阳性男性的VMMC扩大方案的有效性（避免一次HIV感染所需的VMMC数量）。通过拟合1990 - 2014年艾滋病流行时间趋势数据对模型进行了校准。我们假设HIV阳性男性的包容性可能通过增加高风险男性的VMMC摄取或通过包皮环切降低HIV男性对女性的传播风险而使VMMC项目受益。所有的分析都是在假设没有进一步扩大抗逆转录病毒治疗（ART）的情况下产生的。在只对艾滋病毒阴性的男性进行包皮环切的项目中，每避免一次艾滋病毒感染所需的包皮环切手术数量预计将从12.2例增加到14.0例，其中包括艾滋病毒阳性的男性。艾滋病毒阳性男性的比例是根据其在人口中的代表性来确定的（例如，根据2010年男性艾滋病毒感染率为12.6%，2010年行包皮环切术的男性中有12.6%为艾滋病毒阳性）。然而，如果一个项目只针对艾滋病毒阴性的男性，那么高风险男性的感染率会降低20%，那么每次避免感染的有效性将达到13.2个vmcs。如果艾滋病毒阳性男性的包容性提高与高危男性的吸收率提高20%相关，则有效性为12.4。假设VMMC对男性向女性传播艾滋病毒的有效性从0%增加到20%和46%，无论艾滋病毒状况如何，包皮环切术的有效性分别从14.0提高到11.5和9.1。女性艾滋病毒感染率相应下降，分别从24.7%上升到34.8%和50.4%。结论提高男性在VMMC项目中的包容性，无论艾滋病毒状况如何，如果高危男性的VMMC摄取适度增加，或者VMMC防止男性向女性传播的效果适度，则可以提高VMMC的有效性。在这种情况下，自愿生殖生殖医学项目减少男性艾滋病毒发病率的效果几乎与一些抗逆转录病毒治疗项目所预期的一样多，此外，女性从干预中受益的程度几乎与男性一样多。
BackgroundThe epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example.Methods and FindingsWe used the Age-Structured Mathematical (ASM) model to evaluate, over an intermediate horizon (2010-2025), the effectiveness (number of VMMCs needed to avert one HIV infection) of VMMC scale-up scenarios with varying proportions of HIV-positive males. The model was calibrated by fitting to HIV prevalence time trend data from 1990 to 2014. We assumed that inclusivity of HIV positive males may benefit VMMC programs by increasing VMMC uptake among higher risk males, or by circumcision reducing HIV male-to-female transmission risk. All analyses were generated assuming no further antiretroviral therapy (ART) scale-up.The number of VMMCs needed to avert one HIV infection was projected to increase from 12.2 VMMCs per HIV infection averted, in a program that circumcises only HIV-negative males, to 14.0, in a program that includes HIV-positive males. The proportion of HIV-positive males was based on their representation in the population (e.g. 12.6% of those circumcised in 2010 would be HIV-positive based on HIV prevalence among males of 12.6% in 2010). However, if a program that only reaches out to HIV-negative males is associated with 20% lower uptake among higher-risk males, the effectiveness would be 13.2 VMMCs per infection averted. If improved inclusivity of HIV-positive males is associated with 20% higher uptake among higher-risk males, the effectiveness would be 12.4. As the assumed VMMC efficacy against male-to-female HIV transmission was increased from 0% to 20% and 46%, the effectiveness of circumcising regardless of HIV status improved from 14.0 to 11.5 and 9.1, respectively. The reduction in the HIV incidence rate among females increased accordingly, from 24.7% to 34.8% and 50.4%, respectively.ConclusionImproving inclusivity of males in VMMC programs regardless of HIV status increases VMMC effectiveness, if there is moderate increase in VMMC uptake among higher-risk males and/or if there is moderate efficacy for VMMC against male-to-female transmission. In these circumstances, VMMC programs can reduce the HIV incidence rate in males by nearly as much as expected by some ART programs, and additionally, females can benefit from the intervention nearly as much as males.