Table 2.
Observational studies of circumcision and HIV prevalence in men in communities with substantial circumcision scale‐up
| Study (first author publication year) | Setting and location | Period | HIV prevalence – % (n/N) † | Prevalence ratio (95% CI) | Notes | |||
|---|---|---|---|---|---|---|---|---|
| Auvert 2013 [33] | Orange Farm, South Africa |
Baseline: Oct‐2007 – Apr‐2008 Follow‐up: Oct‐2010 – Jun‐2011 |
Baseline: Circ. 7.2% (15/208) Not circ. 17.2% (96/558) Follow‐up: Circ. 6.6%(117/1771) Not circ. 18.6%(295/1567) Both survey rounds Circ. 6.7% (132/1979) Not circ. 18.4% (391/2125) |
Crude 0.42 (0.25‐0.71) a Adj. 0.45 (0.26‐0.79) b
Crude 0.35 (0.29‐0.43) a Adj. 0.49 (0.38‐0.62) c
Crude 0.36 (0.30‐0.44) Adj. 0.48 (0.39‐0.60) |
Baseline HIV prevalence from subset of 766 men (27% circumcised) ages 22 to 34 years (Lissouba 2011 [33]). Circumcision prevalence in men ages 15‐49 years increased from 17% (329/1988) at baseline to 53% (1771/3338) at follow‐up survey. ART use in HIV‐positive men increased from 13% (38/288) at baseline to 26% (109/412) at follow‐up survey. |
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| Kagaayi 2019 [37] | Fishing Communities, Lake Victoria, Uganda | Five survey rounds from Dec‐2011 to Dec‐2016 |
2011 survey: Circ. 25% (173/698) Not circ. 39% (518/1313) 2012 survey: Circ. 25% (218/883) Not circ.40% (499/1243) 2013 survey: Circ. 25% (264/1075) Not circ 41% (402/988) 2015 survey: Circ 24% (304/1249) Not circ.42% (383/905) 2016 survey: Circ. 25% (409/1630) Not circ. 44% (391/894) All survey rounds Circ. 25% (1368/5535) Not circ. 41% (2193/5344) |
Crude 0.63 (0.54‐0.73) a Adj. Not reported
Crude 0.61 (0.54‐0.70) a Adj. Not reported
Crude 0.60 (0.53‐0.69) a Adj. Not reported
Crude 0.58 (0.51‐0.65) a Adj. Not reported
Crude 0.58 (0.51‐0.64) a Adj. Not reported
Crude 0.60 (0.57 to 0.64) a Pooled 0.60 (0.56 to 0.63) d Adj. 0.67 (0.62 to 0.73) e |
Circumcision and ART prevalence by survey round | |||
| Survey | Circumcision | ART women | ART men | |||||
| 2011 | 35% (698/2011) | 18% (164/907) | 13% (90/691) | |||||
| 2012 | 42% (883/2126) | 31% (259/844) | 18% (127/717) | |||||
| 2013 | 52% (1075/2063) | 49% (417/856) | 34% (228/666) | |||||
| 2015 | 58% (1249/2154) | 72% (648/900) | 56% (382/687) | |||||
| 2016 | 65% (1630/2525) | 85% (797/940) | 78% (623/799) | |||||
| Pooled |
Circ. 20% (1485/7306) Not circ.36% (2487/6910) |
Crude 0.58 (0.55 to 0.61) Adj. 0.65 (0.60 to 0.70) f |
Absolute difference g : 148 fewer (from 134 to 162 fewer) per 1000 men Heterogeneity statistics: I 2 = 82.3%, χ2 (1) = 5.65, p = 0.017 |
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Percent (number with infection/ Number tested)
Computed from reported number of infections and number tested
Adjusted for age, ethnic group, marital status, number of lifetime sexual partners, number of sexual partners in the past 12 months, consistent condom use with non‐spousal partners and HSV‐2 status using Poisson regression model
Adjusted for age group
Weighted average over all 5 survey rounds. Heterogeneity: I 2 = 0.0%, χ2 (4) = 1.45, p = 0.83
Adjusted for demographics (gender, age, marital status, education) and sexual behaviours (number of sexual partners in the previous 12 months, sex with partners outside the community of residence, sex with non‐marital partners, condom use and self‐reported genital ulceration)
Weighted average of log adjusted prevalence ratios with weights inversely proportional to variance back‐transformed to ratio scale
Computed from pooled adjusted prevalence ratio, confidence interval and prevalence in uncircumcised men.