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Rakai Health Sciences Program(RHSP) Uganda WHO Country Update Meeting Arusha- June 8-10, 2010 Adrian M Musiige  (MBChB/MPH...
<ul><li>Community Effects of MC on HIV Epidemic with Nested Clinical Research </li></ul><ul><li>HIV, STIs, and behaviors i...
A community hub where men are seen for their post trial follow up visits Rakai District;  South Western Uganda Rakai Cohor...
<ul><li>Post Trial community Surveillance </li></ul><ul><ul><li>Acceptance, Behavior, HIV Acquisition/Transmission </li></...
Number of sex partners  during the trial (years 1-2) and during post-trial surveillance (years 3-4),  by circumcision stat...
<ul><li>Long term follow up </li></ul><ul><ul><li>Effectiveness of Circ on HIV/STI prevention </li></ul></ul><ul><ul><li>E...
<ul><li>Transmission in the foreskin supplement </li></ul><ul><li>Earliest events and virus-host cell interactions in HIV ...
<ul><li>HPV testing supplement </li></ul><ul><li>To assess efficacy of MC for HR HPV prevention in HIV+ and HIV- men </li>...
MC and STI; recent findings Effect of MC Reference HR HPV in (-)Men Decreased Acquisition Increased Clearance Ronald H Gra...
<ul><li>Correlation between the burden of genital anaerobes and inflammatory markers in HIV uninfected men and their femal...
Focal Inflammation in the Foreskin (left) and densities of CD4 and CD8 cells (lower panel) Preparing the prepuce for stora...
<ul><li>Studies on Long term efficacy of MC </li></ul><ul><li>Community level effectiveness of MC on HIV/STI prevention  <...
<ul><li>Research Grants </li></ul><ul><ul><li>NIAID </li></ul></ul><ul><ul><li>Bill & Melinda Gates Foundation </li></ul><...
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Overview of male circumcision research in Uganda - Presented ...

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Transcript of "Overview of male circumcision research in Uganda - Presented ..."

  1. 1. Rakai Health Sciences Program(RHSP) Uganda WHO Country Update Meeting Arusha- June 8-10, 2010 Adrian M Musiige (MBChB/MPH) MC Trainer / Coordinator Rakai Community Cohort Study
  2. 2. <ul><li>Community Effects of MC on HIV Epidemic with Nested Clinical Research </li></ul><ul><li>HIV, STIs, and behaviors in a RCT & post-Trial Surveillance </li></ul><ul><ul><li>In Situ analysis of HIV transmission in foreskin & </li></ul></ul><ul><ul><li>HPV Testing Supplements </li></ul></ul><ul><li>Genital anaerobes, inflammation and HIV risk, Rakai </li></ul>
  3. 3. A community hub where men are seen for their post trial follow up visits Rakai District; South Western Uganda Rakai Cohort Annual Surveillance N=15000 Age 15-49
  4. 4. <ul><li>Post Trial community Surveillance </li></ul><ul><ul><li>Acceptance, Behavior, HIV Acquisition/Transmission </li></ul></ul><ul><ul><li>Impact at Individual & Population level </li></ul></ul><ul><li>Relevant Clinical Research </li></ul><ul><ul><li>Healing by HIV status </li></ul></ul><ul><ul><li>Surgical stress on HIV viral load </li></ul></ul><ul><ul><li>HIV shedding from surgical wound </li></ul></ul><ul><li>Foreskin Inflammation and mucosal Immunology studies </li></ul><ul><ul><li>Mucosal Barriers and susceptibility to HIV </li></ul></ul><ul><ul><ul><li>Mucosal Immunological and inflammatory characteristics in HIV- men with and without HIV exposure </li></ul></ul></ul>
  5. 5. 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
  6. 6. <ul><li>Long term follow up </li></ul><ul><ul><li>Effectiveness of Circ on HIV/STI prevention </li></ul></ul><ul><ul><li>Effect of Circ on sexual behaviors </li></ul></ul><ul><li>MC and STI Prevention </li></ul><ul><ul><li>STI assays on stored trial samples </li></ul></ul>
  7. 7. <ul><li>Transmission in the foreskin supplement </li></ul><ul><li>Earliest events and virus-host cell interactions in HIV transmission </li></ul><ul><ul><li>New HIV Sero-positive </li></ul></ul><ul><ul><li>New PCR+ but Sero-negative </li></ul></ul><ul><li>To determine basis for low F  M transmission using foreskin studies of HIV- men in discordant relationships n=50 </li></ul>
  8. 8. <ul><li>HPV testing supplement </li></ul><ul><li>To assess efficacy of MC for HR HPV prevention in HIV+ and HIV- men </li></ul><ul><li>To assess efficacy of MC in preventing HR HPV in female partners of HIV+ and HIV- men </li></ul>
  9. 9. MC and STI; recent findings Effect of MC Reference HR HPV in (-)Men Decreased Acquisition Increased 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 HSV2 Significantly 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 significantly Ronald 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
  10. 10. <ul><li>Correlation between the burden of genital anaerobes and inflammatory markers in HIV uninfected men and their female partners </li></ul><ul><li>Association Genital anaerobes, Inflammatory markers and risk of HIV acquisition/transmission </li></ul><ul><li>Estimate role of genital anaerobes and inflammation in the efficacy of MC </li></ul>
  11. 11. 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
  12. 12. <ul><li>Studies on Long term efficacy of MC </li></ul><ul><li>Community level effectiveness of MC on HIV/STI prevention </li></ul><ul><li>Effect of MC on sexual behavior </li></ul><ul><li>Mucosal Immunological studies </li></ul><ul><li>The potential mediating role of genital micro-biota and inflammation in efficacy of MC </li></ul>
  13. 13. <ul><li>Research Grants </li></ul><ul><ul><li>NIAID </li></ul></ul><ul><ul><li>Bill & Melinda Gates Foundation </li></ul></ul><ul><li>Circumcision Service & Provider Training </li></ul><ul><ul><li>PEPFAR </li></ul></ul>
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