Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
- PMID: 17321310
- DOI: 10.1016/S0140-6736(07)60312-2
Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
Abstract
Background: Male circumcision could provide substantial protection against acquisition of HIV-1 infection. Our aim was to determine whether male circumcision had a protective effect against HIV infection, and to assess safety and changes in sexual behaviour related to this intervention.
Methods: We did a randomised controlled trial of 2784 men aged 18-24 years in Kisumu, Kenya. Men were randomly assigned to an intervention group (circumcision; n=1391) or a control group (delayed circumcision, 1393), and assessed by HIV testing, medical examinations, and behavioural interviews during follow-ups at 1, 3, 6, 12, 18, and 24 months. HIV seroincidence was estimated in an intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, with the number NCT00059371.
Findings: The trial was stopped early on December 12, 2006, after a third interim analysis reviewed by the data and safety monitoring board. The median length of follow-up was 24 months. Follow-up for HIV status was incomplete for 240 (8.6%) participants. 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped. The 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065); the relative risk of HIV infection in circumcised men was 0.47 (0.28-0.78), which corresponds to a reduction in the risk of acquiring an HIV infection of 53% (22-72). Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrollment, the protective effect of circumcision was 60% (32-77). Adverse events related to the intervention (21 events in 1.5% of those circumcised) resolved quickly. No behavioural risk compensation after circumcision was observed.
Interpretation: Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa. Where appropriate, voluntary, safe, and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible.
Comment in
-
Male circumcision to cut HIV risk in the general population.Lancet. 2007 Feb 24;369(9562):617-9. doi: 10.1016/S0140-6736(07)60288-8. Lancet. 2007. PMID: 17321292 No abstract available.
-
Male circumcision in HIV prevention.Lancet. 2007 May 12;369(9573):1597-8; author reply 1598-9. doi: 10.1016/S0140-6736(07)60736-3. Lancet. 2007. PMID: 17499589 No abstract available.
-
Male circumcision in HIV prevention.Lancet. 2007 May 12;369(9573):1597; author reply 1598-9. doi: 10.1016/S0140-6736(07)60734-X. Lancet. 2007. PMID: 17499590 No abstract available.
-
Male circumcision in HIV prevention.Lancet. 2007 May 12;369(9573):1597; author reply 1598-9. doi: 10.1016/S0140-6736(07)60735-1. Lancet. 2007. PMID: 17499591 No abstract available.
-
Male circumcision in HIV prevention.Lancet. 2007 May 12;369(9573):1598; author reply 1598-9. doi: 10.1016/S0140-6736(07)60737-5. Lancet. 2007. PMID: 17499593 No abstract available.
-
Words of wisdom. Re: Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial, and Re: Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial.Eur Urol. 2007 Aug;52(2):605-6. doi: 10.1016/j.eururo.2007.04.090. Eur Urol. 2007. PMID: 17674440 No abstract available.
-
Circumcision reduced the risk of contracting HIV infection in young sexually active Kenyan men.Evid Based Med. 2007 Aug;12(4):104. doi: 10.1136/ebm.12.4.104. Evid Based Med. 2007. PMID: 17885152 No abstract available.
Similar articles
-
Male circumcision for prevention of heterosexual acquisition of HIV in men.Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003362. doi: 10.1002/14651858.CD003362.pub2. Cochrane Database Syst Rev. 2009. PMID: 19370585 Review.
-
Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.Lancet. 2007 Feb 24;369(9562):657-66. doi: 10.1016/S0140-6736(07)60313-4. Lancet. 2007. PMID: 17321311 Clinical Trial.
-
Uptake of antiretroviral therapy and male circumcision after community-based HIV testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and Uganda.Lancet HIV. 2016 May;3(5):e212-20. doi: 10.1016/S2352-3018(16)00020-5. Epub 2016 Mar 10. Lancet HIV. 2016. PMID: 27126488 Free PMC article. Clinical Trial.
-
The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial.Lancet HIV. 2015 May;2(5):e181-9. doi: 10.1016/S2352-3018(15)00042-9. Lancet HIV. 2015. PMID: 26120594 Free PMC article. Clinical Trial.
-
Male circumcision to reduce sexual transmission of HIV.Curr Opin HIV AIDS. 2010 Jul;5(4):344-9. doi: 10.1097/COH.0b013e32833a46d3. Curr Opin HIV AIDS. 2010. PMID: 20543611 Review.
Cited by
-
Knowledge, Attitudes, Practices, and Acceptability of Medical Male Circumcision among Males in Traditionally Circumcising Rural Communities of Alfred Nzo District, Eastern Cape, South Africa.Int J Environ Res Public Health. 2023 Nov 21;20(23):7091. doi: 10.3390/ijerph20237091. Int J Environ Res Public Health. 2023. PMID: 38063521 Free PMC article.
-
Seroprevalence and factors associated with Hepatitis B virus infection among students in two senior high schools in the Krachi Nchumuru district in Ghana-A cross-sectional study.BMC Res Notes. 2023 Dec 2;16(1):358. doi: 10.1186/s13104-023-06624-4. BMC Res Notes. 2023. PMID: 38042854 Free PMC article.
-
Decellularization techniques of human foreskin for tissue engineering application.Physiol Res. 2023 Oct 27;72(S3):S287-S297. doi: 10.33549/physiolres.935185. Physiol Res. 2023. PMID: 37888972 Free PMC article.
-
Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis.BMC Health Serv Res. 2023 Sep 29;23(1):1044. doi: 10.1186/s12913-023-10016-6. BMC Health Serv Res. 2023. PMID: 37773121 Free PMC article.
-
HIV, syphilis, and hepatitis B virus infection and male circumcision in five Sub-Saharan African countries: Findings from the Population-based HIV Impact Assessment surveys, 2015-2019.PLOS Glob Public Health. 2023 Sep 18;3(9):e0002326. doi: 10.1371/journal.pgph.0002326. eCollection 2023. PLOS Glob Public Health. 2023. PMID: 37721926 Free PMC article.
Publication types
MeSH terms
Associated data
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical