Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa
Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa
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DOI：
10.1186/1471-2334-7-16
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发表时间：
2007-03-13
影响因子：
3.7
通讯作者：
Bailey, Robert C.
中科院分区：
文献类型：
--
作者：
Nagelkerke, Nico J. D.;Moses, Stephen;Bailey, Robert C.
背景：最近在非洲进行的临床试验以及几项观察性流行病学研究提供的证据表明，男性包皮环切术可将艾滋病毒女性向男性传播的风险降低60%或更多。然而，大规模男性包皮环切术对艾滋病预防的公共卫生影响尚不清楚。方法：研究了两个数学模型来探讨这个问题：一个是随机混合模型，另一个是区分与性工作相关的风险群体的分区模型。在分区模型中，开发了两种情景，一种是在类似于博茨瓦纳的情况下计算艾滋病毒的传播和流行情况，另一种是类似于肯尼亚西部的尼扬扎省。结果：在这两个模型中，男性包皮环切术项目导致男性和女性的艾滋病毒感染率随着时间的推移而持续大幅下降。男性的受益程度略高于女性，但女性的患病率也大幅下降。男性包皮环切覆盖率达到80%，这两个“国家”的患病率下降幅度从45%到67%不等，而覆盖率达到50%，则从25%到41%不等。干预措施要达到其全部效果需要十多年的时间。结论：在艾滋病毒流行率高的非洲国家，以及目前尚未常规实施男性包皮环切术的国家，大规模采用男性包皮环切服务可能会导致艾滋病毒在男性和女性中的传播和流行随着时间的推移而大幅减少。
Background: Recent clinical trials in Africa, in combination with several observational epidemiological studies, have provided evidence that male circumcision can reduce HIV female-to-male transmission risk by 60% or more. However, the public health impact of large-scale male circumcision programs for HIV prevention is unclear.Methods: Two mathematical models were examined to explore this issue: a random mixing model and a compartmental model that distinguishes risk groups associated with sex work. In the compartmental model, two scenarios were developed, one calculating HIV transmission and prevalence in a context similar to the country of Botswana, and one similar to Nyanza Province, in western Kenya.Results: In both models, male circumcision programs resulted in large and sustained declines in HIV prevalence over time among both men and women. Men benefited somewhat more than women, but prevalence among women was also reduced substantially. With 80% male circumcision uptake, the reductions in prevalence ranged from 45% to 67% in the two "countries", and with 50% uptake, from 25% to 41%. It would take over a decade for the intervention to reach its full effect.Conclusion: Large-scale uptake of male circumcision services in African countries with high HIV prevalence, and where male circumcision is not now routinely practised, could lead to substantial reductions in HIV transmission and prevalence over time among both men and women.