Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa
Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa
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DOI：
10.1186/s12916-020-01635-5
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发表时间：
2020-07-07
期刊：
影响因子：
9.3
通讯作者：
Dwyer-Lindgren, Laura
中科院分区：
文献类型：
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作者：
Cork, Michael A.;Wilson, Kate F.;Dwyer-Lindgren, Laura
艾滋病毒仍然是撒哈拉以南非洲育龄男女疾病负担的最大原因。自愿医疗男性包皮环切术（VMMC）将女性向男性传播艾滋病毒的风险降低了50- 60%。世界卫生组织（世卫组织）和联合国艾滋病毒/艾滋病联合规划署（艾滋病规划署）确定了VMMC运动的14个优先国家，并为15-49岁的男性设定了80%的覆盖率目标。从2008年到2017年，重点国家报告了超过1800万例VMMC。然而，相对较少的是知道当地的变化，男性包皮环切术（MC）的流行。方法：我们分析了地理位置的MC流行率数据，从109个家庭调查使用贝叶斯地统计建模框架，以估计成人MC流行率和包皮环切术和未包皮环切术的人数，年龄在15-49岁，在撒哈拉以南非洲的38个国家在5 × 5公里的分辨率和第一行政级别（通常是省或州）和第二行政级别（通常是区或县）单位。我们发现MC患病率在国家内和国家间存在显著差异;大多数（14个中的12个）优先国家在2017年估计患病率最高和最低的第一行政级别单位之间的差异超过两倍。虽然随着VMMC运动的开始，所有优先国家的估计全国MC流行率都有所增加，但有7个优先国家在VMMC运动开始后，既有估计MC流行率增加的国家以下地区，也有估计MC流行率下降的地区。2017年，只有三个优先国家（埃塞俄比亚、肯尼亚和坦桑尼亚）可能在国家层面达到80%的MC覆盖率目标，没有一个优先国家可能在所有国家以下地区实现这一目标。结论尽管自2008年VMMC运动开始以来，所有优先国家的MC患病率都有所增加，但在大多数国家以下地区，MC患病率仍低于80%的覆盖率目标，并且变化很大。这些绘制的结果提供了一个可操作的工具，用于了解当地的需求，并为VMMC干预措施提供信息，以便在继续努力结束撒哈拉以南非洲的艾滋病毒流行方面产生最大影响。
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 x 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.