overview of male circumcision research in uganda - presented
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![Page 1: Overview of male circumcision research in Uganda - Presented](https://reader036.vdocument.in/reader036/viewer/2022062312/553b4a6e4a7959ac798b4661/html5/thumbnails/1.jpg)
Rakai Health Sciences Program(RHSP)
UgandaWHO Country Update Meeting
Arusha- June 8-10, 2010
Adrian M Musiige (MBChB/MPH)
MC Trainer / Coordinator Rakai Community Cohort Study
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Community Effects of MC on HIV Epidemic with Nested Clinical Research
HIV, STIs, and behaviors in a RCT & post-Trial Surveillance In Situ analysis of HIV transmission in foreskin
& HPV Testing Supplements
Genital anaerobes, inflammation and HIV risk, Rakai
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A community hub where men are seen for their post trial follow up visits
Rakai District; South Western Uganda
Rakai CohortAnnual SurveillanceN=15000 Age 15-49
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Post Trial community Surveillance• Acceptance, Behavior, HIV
Acquisition/Transmission• Impact at Individual & Population level
Relevant Clinical Research• Healing by HIV status• Surgical stress on HIV viral load• HIV shedding from surgical wound
Foreskin Inflammation and mucosal Immunology studies• Mucosal Barriers and susceptibility to HIV
Mucosal Immunological and inflammatory characteristics in HIV- men with and without HIV exposure
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Number of sex partners during the trial (years 1-2) and during post-trial surveillance (years 3-4), by circumcision status
Condom use during the trial (years 1-2) and post-trial surveillance (years 3-4) by circumcision status
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Long term follow up• Effectiveness of Circ on HIV/STI prevention• Effect of Circ on sexual behaviors
MC and STI Prevention• STI assays on stored trial samples
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Transmission in the foreskin supplement Earliest events and virus-host cell
interactions in HIV transmission• New HIV Sero-positive • New PCR+ but Sero-negative
To determine basis for low F M transmission using foreskin studies of HIV- men in discordant relationships n=50
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HPV testing supplement
To assess efficacy of MC for HR HPV prevention in HIV+ and HIV- men
To assess efficacy of MC in preventing HR HPV in female partners of HIV+ and HIV- men
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Effect of MC Reference
HR HPV in (-)Men
Decreased AcquisitionIncreased Clearance
Ronald H Gray et al. J Infect Dis 2010 Apr. 6
HR HPV in (+)Men
Reduced Prevalence and Incidence of 12/14 HR genotypes
David Serwadda et al. AIDS 2010 Mar 13; 24(5): 787
HSV2Significantly reduced cumulative probability of infection, 28% Efficacy
Aaron A R Tobian et al. Lancet 2009- Jul.18; 374(9685): 229-37
Syphilis No effect
Bacterial Vaginosis
Decreased significantlyRonald H Gray et al.Am J Obstet and Gynecol 2009 Jan; 200(1): 42 e1-42. e7
T. Vaginalis Decreased Significantly
Role of GUD & HSV2 reduction in MC efficacy
Only 19% of the protection
MC and STI; recent findings
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Correlation between the burden of genital anaerobes and inflammatory markers in HIV uninfected men and their female partners
Association Genital anaerobes, Inflammatory markers and risk of HIV acquisition/transmission
Estimate role of genital anaerobes and inflammation in the efficacy of MC
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Focal Inflammation in the Foreskin (left) and densities of CD4 and CD8 cells (lower panel)
Preparing the prepuce for storage
n NMDS plot of penile microbiota before surgery and at follow up post surgery
Foreskin Surface area and HIV acquisition in Rakai, Uganda (Size Matters) Kigozi G et al. AIDS: 23 Oct 2009 - Volume 23 - Issue 16 - p 2209-2213
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Studies on Long term efficacy of MC Community level effectiveness of MC
on HIV/STI prevention Effect of MC on sexual behavior Mucosal Immunological studies The potential mediating role of
genital micro-biota and inflammation in efficacy of MC
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Research Grants•NIAID
•Bill & Melinda Gates Foundation
Circumcision Service & Provider Training
•PEPFAR