Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs

Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV

Population-Level Impact Of A Medical Male Circumcision Program To Prevent HIV Infection: Kenya 2008–2011

Multiple observational studies, confirmed by three randomized control trials, have demonstrated beyond any reasonable doubt that medical male circumcision reduces the risk of female-to-male transmission of HIV. Despite this conclusive evidence and available funding, a lack of information on the longer-term population-level impact of voluntary male medical circumcision (VMMC) programs has proven one barrier to planning and scale-up of circumcision services. To help address this lack of knowledge regarding long-term effectiveness we conducted a series of population-level surveys to describe the impact of a large-scale VMMC program in a community specifically targeted by the world’s most successful national VMMC program in Kisumu, Kenya. The circumcision impact study (CIRCIS) is a series of cross-sectional surveys, each designed to represent the low-to-middle income population of Kisumu municipality at specific time-points during the progression of Kenya’s VMMC program. In this thesis we describe changes in circumcision-related knowledge and beliefs with the identification of associations that may indicate community-wide risk compensation, quantify changes in MC prevalence, describe factors associated with program uptake, and explore the impact of increased circumcision prevalence to the HIV epidemic in this population. We were able to confirm the protective effect of circumcision at the population level and identified a number of important co-factors of HIV infection. VMMC uptake was 24% between 2008 and 2011 resulting in a significant increase in circumcision prevalence from 33.0% to 49.5%. There was significant variation in circumcision uptake across sociodemographic categories with the largest gains observed in young men (<19 years), especially those not yet sexually active, and students. These men are currently at low risk of HIV; however, they are likely to change their risk behaviors as they age. Lastly, we found no evidence of population-level increases in HIV risk behaviors or risk compensation. Our results should help inform VMMC scale-up in Kenya and throughout the region, enabling policy makers to make evidence-based decisions about VMMC programming

Demographic factors and beliefs about HIV by preference for circumcision in uncircumcised men – Kisumu, Kenya.

<p>Demographic factors and beliefs about HIV by preference for circumcision in uncircumcised men – Kisumu, Kenya.</p

Association of MC preference in uncircumcised men with STI infection and high risk behaviors.

<p>*Statistically significant association (p≤.05),</p>†<p>Controlling for age, number of sex partners, ethnic group (Luo/non-Luo), and marriage status.</p>§<p>Controlling for age.</p>‡<p>Difference by Kolmogorov-Smirnov test for comparing two groups.</p

Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014

We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1–2.6) to 0.1 (95% CI 0.02–0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04–0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60–74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4–0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival

Secondary Infections with Ebola Virus in Rural Communities, Liberia and Guinea, 2014–2015

Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities