Voluntary Medical Male Circumcision for HIV Prevention: a Global Overview

Male infant circumcision and associated factors in Konso Zone Southern Ethiopia: community based survey

BACKGROUND

Infant male circumcision reduces urinary tract infections during infancy and sexually transmitted infections during adulthood. However, people in varous communities challenge male infant circumsizion in Ethiopia. Data regrading male infant circumsion is crucial component of designing preventive strategy, resource allocation and planning mainly in rural communities. Despite its importance, no study is conducted on male infant circumsion practice and associated factors in the study setting so far.

OBJECTIVE

To assess prevalence and factors associated with male infant circumcision in Konso Zone, South Nation Nationality People Regional State of Ethiopia, in 2022.

METHODS AND MATERIALS

Community-based cross-sectional survey was conducted among randomly selected districts in Konso Zone, Southern Nation Nationality and Peoples Regional States, Ethiopia, from 30 June to 30 July 2022. A multi-stage sampling technique was applied to enrol study subjects. Data was collected through face-to-face interviews using a structured questionnaire. Then, it was entered into epi-data 4.6 and exported to STATA version 14 for analysis. Descriptive statistics were presented using tables,charts and texts. Bivariate and multivariable logistic regression analysis were used to evaluate association between each independent variable and dependent variable. All explanatory variables with P-value less than 0.25 in bivariate regression were fitted into multi-variable regression. Variables whose P-value less than 0.05 with 95% confidence intervals (CI) was used to declare statically significance.

RESULTS

Prevalence of male infant circumcision was 24.9% in this study. Factors such as women with good knowledge of male circumcision (AOR = 7.3; 95% CI: 4.3, 12.5), women age more than 36 years (AOR = 2.2; 95% CI: 1.1, 4.3) and women with a favourable attitude to male circumcision (AOR = 9.2; 95% CI: 4.5, 18.8) were significantly associated with male infant circumcision practice in this study.

CONCLUSION

Prevalence of male infant circumcision was lower in this study compared to national threshold. Women knowledge towards male infant circumcision, aged more than 36 years, and women with favourable attitude to male circumcision are factors positively associated with male infant circumcision. Hence, stakeholders should empower women using health education about male infant circumcision and mobilise the community.

Utilization of subcutaneous indwelling 2-0 silk thread for inner plate frenulum alignment in circumcision using a disposable circumcision suture device: A modified surgical technique

BACKGROUND

This prospective nonrandomized controlled study aimed to compare the surgical outcomes, postoperative complications, and patient experiences between a modified circumcision technique using a disposable circumcision suture device and the standard circumcision method using a disposable circumcision suture device in Chinese patients with excess foreskin or phimosis at our department of urology and andrology.

MATERIALS AND METHODS

A total of 456 patients underwent circumcision at our center from May 2021 to September 2022, with 228 patients in the modified disposable circumcision suture device group (mean age: 29.8 years; range: 16.8-44.9 years) and 228 patients in the disposable circumcision suture device group (mean age: 29.6 years; range: 16.4-45.1 years). Key surgical outcomes, including surgical time, intraoperative blood loss, postoperative edema duration, time for complete shedding of titanium pins, and incision healing time, were recorded and analyzed. Additionally, postoperative complications (such as injury to the penile frenulum, frenulum misalignment, glans ischemia, severe bleeding, and infection) as well as patient experiences (including intraoperative and postoperative pain scores and satisfaction with the cosmetic appearance of the penis) were evaluated.

RESULTS

All surgeries were successfully completed. The surgical duration was significantly longer in the modified disposable circumcision suture device group (5.7 ± 0.5 minutes) compared to the disposable circumcision suture device group (4.2 ± 0.6 minutes) (P < .05), indicating that the modified procedure took longer to perform. However, no significant differences were found between the 2 groups regarding intraoperative blood loss (3.2 ± 0.2 mL vs 3.2 ± 0.1 mL; P > .05), postoperative edema duration (8.2 ± 2.0 days vs 8.9 ± 1.9 days; P > .05), time for complete shedding of titanium pins (13.7 ± 1.3 days vs 13.8 ± 1.3 days; P > .05), and healing time (21.8 ± 1.7 days vs 21.9 ± 1.8 days; P > .05). The incidence of complications, including injury to the penile frenulum (0% vs 0%), glans ischemia (0% vs 0%), severe bleeding (1.3% vs 1.8%), and infection (2.6% vs 3.1%), was comparable between the 2 groups (P > .05 for all comparisons). Notably, the incidence of frenulum misalignment was significantly lower in the modified disposable circumcision suture device group (2.2% vs 16.7% in the disposable circumcision suture device group; P < .05). Moreover, patient satisfaction with the cosmetic appearance of the penis was higher in the modified disposable circumcision suture device group compared with the disposable circumcision suture device group (96.5% vs 86.8%; P < .05). The pain scores recorded during and after the procedures showed no significant intergroup differences (intraoperative: 1.7 ± 1.0 vs 1.7 ± 0.9; postoperative: 1.3 ± 1.0 vs 1.3 ± 1.0; P > .05 for all comparisons).

CONCLUSION

The modified circumcision technique using a DCSD is associated with a longer operative time; however, it effectively minimizes the risk of preputial frenulum misalignment and enhances postoperative cosmetic satisfaction.

Disparities in PrEP use and unmet need across PEPFAR-supported programs: doubling down on prevention to put people first and end AIDS as a public health threat by 2030

Background

In 2023, an estimated 1.3 million people newly acquired HIV. In the same year, 3.5 million individuals received pre-exposure prophylaxis (PrEP), falling short of the UNAIDS target of 21.2 million by 2025. With over 90% of global PrEP programming supported by PEPFAR, a better understanding of disparities in PrEP provision is needed to inform PEPFAR's approach to reach and deliver prevention services and achieve UNAIDS 95-95-95 goals in all populations by 2025. The objective of this paper is to assess unmet PrEP need in PEPFAR-supported countries.

Methods

We analyzed FY2023 Monitoring, Evaluation, and Reporting (MER) results from 48 PEPFAR-supported countries to calculate PrEP-to-need ratios (PnR) by geography and population. PnR offers an ecological measure to identify disparities and missed opportunities for PrEP programming. PnR was calculated as the ratio of PrEP users to the number of positive HIV tests. PrEP users are defined through new initiations (PrEP_NEW) and re-initiations or continuation (PrEP_CT). HTS_TST_POS measures the number of positive HIV tests and was used as a proxy for new diagnoses. PnR was also calculated using Naomi-estimated 2023 HIV incidence, where available. A higher PnR indicates more PrEP users relative to PrEP need in a population.

Results

In FY23, 1,760,888 people initiated PrEP, and 1,736,144 people tested positive for HIV. PnR ranged from 0.12 (India) to 6.46 (Brazil), and 19 (40%) countries had fewer PrEP users than positive HIV tests (PnR <1.0). By population, people 15-24 years old, people who inject drugs, and transgender populations had the highest median PnR. When examining estimated HIV incidence, Mozambique and South Africa reported lower than average PnR and higher than average HIV incidence.

Conclusion

PrEP use relative to population need varied greatly by country and subpopulation across PEPFAR programs, suggesting a need for greater advocacy, inclusivity, accessibility, and integrated prevention programming. PnR may be a useful indicator of population PrEP coverage and unmet need, and can inform effective, data-driven, and person-centered PEPFAR prevention programming and policies. Tailoring PrEP scale-up strategies by age, sex, key population, and geography is crucial to achieving UNAIDS targets and ending the AIDS epidemic as a public health threat for all by 2030.

Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review

BACKGROUND

Targeted interventions for key populations remain critical for realisation of epidemic control for human immunodeficiency virus (HIV) infection because of the causal relationship between HIV infection in the general population and among key population groups.

AIM

To consolidate evidence on the fast-track interventions towards achieving HIV epidemic control among key populations.

METHODS

A rapid scoping review was conducted using the methodological framework by Arksey and O' Malley. The Population, Intervention, Context and Outcome (PICO) framework was used to identify relevant studies using key words with Boolean operators in electronic data bases, namely CINHAL, Web of Science, Psych Info and Sabinet. Studies were extracted using a modified data extraction tool, and results were presented narratively.

RESULTS

A total of 19 articles were included in this review. Most articles were primary studies (n = 17), while another involved the review of existing literature and policies (n = 2) and routinely collected data (n = 1). Most studies were conducted in the United States of America (n = 6), while another were conducted in China, Kenya, Botswana, South Africa and Mozambique. All studies revealed findings on tested interventions to achieve HIV epidemic control among key populations.

CONCLUSION

Effective interventions for HIV epidemic control were stand-alone behavioural preventive interventions, stand-alone biomedical preventive strategies and combination prevention approaches. Furthermore, the findings suggest that effective activities to achieve HIV epidemic control among key populations should be centred around prevention.Contribution: The findings of this study have policy and practice implications for high HIV burden settings such as South Africa in terms of interventions to facilitate realisation of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, thereby contributing to HIV epidemic control.

Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review

Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.

Voluntary Medical Male Circumcision to Reduce HIV Acquisition and Transmission

PURPOSE OF REVIEW

This commentary introduces the special Global Health Section on the state of voluntary medical male circumcision (VMMC) programs and current knowledge as to role of VMMC prevention of HIV infection acquisition in men and, indirectly, women.

RECENT FINDINGS

Since the first clinical trial of VMMC in Africa was published in 2005, implementation of programs has depended on illuminating best practices and key obstacles in the effort to expand VMMC in areas of high HIV prevalence to reduce HIV acquisition among men, with consequent benefits that uninfected men will not infect others. Global efforts are focused on sub-Saharan Africa, given the favorable expected impact of VMMC deployment where HIV incidence is high and circumcision rates are low. With estimated field effectiveness estimated to exceed 60%, reduced HIV risk for circumcised men in sub-Saharan Africa based on a once-only minor surgical intervention provides extraordinary preventive benefits. Where high VMMC rates have been achieved, declining HIV incidence rates may be partially or substantially attributed to VMMC, but this remains to be investigated. Articles in this special section address achievements, obstacles and risks, and plans for future progress in partnership with affected communities.