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TRANSCRIPT
Dr. Bertran Auvert
HIV incidence and prevalence among women are associated with their partners' circumcision status
in the township of Orange Farm, South Africa
PEPFAR VMMC Webinar on Women’s Issues: November 19, 2014
• To assess the associaAon between their partner’s circumcision status and HIV incidence and prevalence among women in Orange Farm (South Africa)
ObjecAve
Context -‐ The ANRS « Bophelo Pele » project • Orange Farm: Township of ~110,000 adults
• Since 2007: roll-‐out of free VMMC
2
ORANGE FARM
Context (2) -‐ The ANRS « Bophelo Pele » project
Auvert et al, Plos Med 2013
• MC prevalence increased from 11% in 2007 to 53% in 2011
3
Context (3) -‐ The ANRS « Bophelo Pele » project • HIV prevalence lower by ~50% among circumcised men
compared with uncircumcised men
Auvert et al, Plos Med 2013
4
Data collected among women: 3 independent surveys (2007-‐2010-‐2012)
• QuesWonnaire: age, ethnic group, SES, sexual behavior
• Blood sample: HIV
Methods (1): Data collecWon
5
Pooled sample • N= 4538 women (15-‐49 y) having ever had sexual intercourse
Methods (2): Analyses
• HIV Prevalence: Compared HIV prevalence between women who had had only circumcised partners and all other women
• HIV Incidence: Found the age-‐incidence funcAon that best fit the observed age-‐prevalence curve, adjusted for other covariates
6
Gregson et al, AIDS 1996; Williams et al, Stat Med 2001
N= 4538 women (15-‐49 y) having ever had sexual intercourse
n=1363 (30.0%) women having had only circumcised partners
HIV prevalence rate : 22.4% [20.2% -‐ 24.6%]
n=3175 (70.0%) other women
HIV prevalence rate : 36.6% [35.0% -‐ 38.3%]
0
10
20
30
40
50
60
15–19 20–24 25–29 30–34 35–39 40–49
Age group (years)
HIV
pre
vale
nce
(%)
All partners circumcised
Other
Polynomial (Other)
Polynomial (All partnerscircumcised)
aPRR: adjusted Prevalence Rate RaWo (computed with Poisson regression)
aPRR: 0.85 [0.76-‐0.95] ReducAon: 15% 2[5%-‐24%]
7 Results (1) – HIV prevalence among women
Results (2) – Fifng age-‐specific HIV prevalence 8
0
0.2
0.4
15 20 25 30 35 40 45
Age (years)
HIV
pre
vale
nce
rate
0
0.2
0.4
15 20 25 30 35 40 45
Age (years)
HIV
pre
vale
nce
rate
Women with circumcised partners only : n=1363
Other women: n=3175
Results (3) – EsWmaWng HIV incidence 9
0
0.2
0.4
15 20 25 30 35 40 45
Age (years)
HIV
pre
vale
nce
rate
0
0.2
0.4
15 20 25 30 35 40 45
Age (years)
HIV
pre
vale
nce
rate
Women with circumcised partners only: n=1363
Other women: n=3175
0
0.02
0.04
0.06
14 19 24 29 34 39 44 49
Age (years)
HIV
inci
den
ce r
ate
(/y)
Normal line: Women with circumcised partners only Bold line: Other women
(95% bootstrapped confidence intervals)
Results (4) – Effect on HIV incidence 10
0
0.2
0.4
15 20 25 30 35 40 45
Age (years)
HIV
pre
vale
nce
rate
0
0.2
0.4
15 20 25 30 35 40 45
Age (years)
HIV
pre
vale
nce
rate
Women with circumcised partners only: n=1363
Other women: n=3175
0
0.02
0.04
0.06
14 19 24 29 34 39 44 49
Age (years)
HIV
inci
den
ce r
ate
(/y)
Normal line: Women HHOCP Bold line: Other women
(95% bootstrapped confidence intervals)
Incidence rates among 15-‐49 y • Women with only circumcised partners: • 0.032 [0.027-‐0.037] /py • Other Women: 0.039 [0.036-‐0.042] /py
⇒ Incidence Rate RaAo: 0.83 [0.69-‐0.99] ⇒ ReducAon: 16.9% [1.1%-‐31.0%]
Among 15-‐29 y ⇒ ReducAon: 20.3% [5.8%-‐33.8%]
Discussion 11
Main finding • Reduced HIV incidence and prevalence among women having
only circumcised partners
InterpretaAon • Lower exposure due to a lower prevalence of HIV among
circumcised men LimitaAons • Direct or indirect effect? • HIV incidence modelled, not measured
Acknowledgments
We thank all par@cipants who took part in this study and the whole community of Orange Farm
Por@a Ntshangase Josephine Otchere-‐Darko Dino Rech Thabile Sekhukhune Daniel Shabangu Gaph Sipho Phatedi Yvon de la Soudière Brian Williams
Muhammad Barmania ScoS Billy Alexandre Blake Male Alina Chakela Ewalde Cutler Sasha Frade Agenda Gumbo Mohamed Haffejee
Fikile Kate Bongiwe Klaas Paul Loubet Venessa Maseko Audrey Mkhwanazi Bantu Mupompa Cynthia Nhlapo Grace Nomsa Nhlapho