Page 161 - HIVMED_v21_i1.indb

Page 8 of 9 Original Research

sub-optimal retention relies on the assumption that, Disclaimer
conditional on a set of observed covariates, men who did and Views expressed in the submitted article are our own and do
did not return for follow-up are exchangeable, and its not necessarily reflect the official policy or position of our
appropriateness depends on our ability to identify, measure institutions or funders.
and control for all covariates associated with loss to follow-
up. Based on subject-matter knowledge, we considered 24 References
demographic, socio-economic and behavioural covariates
and 117 two-way interaction terms in the multivariable 1. Auvert B, Taljaard D, Lagarde E, Sobngwi Tambekou J, Sitta R, Puren A. Randomized,
model required by the inverse probability weighting controlled intervention trial of male circumcision for reduction of HIV infection
risk: The ANRS 1265 trial. PLoS Med. 2005;2(11):e298. https://doi.org/10.1371/
procedure. However, as with any observational study, bias journal.pmed.0020298
because of unmeasured factors is possible. 2. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men
in Rakai, Uganda: A randomised trial. Lancet. 2007;369(9562):657–666. https://
doi.org/10.1016/S0140-6736(07)60313-4
Conclusion 3. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young
men in Kisumu, Kenya: A randomised controlled trial. Lancet. 2007;369(9562):
Despite these limitations, our results provide reassurance 643–656. https://doi.org/10.1016/S0140-6736(07)60312-2
that men undergoing VMMC in Botswana are unlikely to be 4. Auvert B, Marseille E, Korenromp EL, et al. Estimating the resources needed and
savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa.
systematically engaging in risk compensation. Such PLoS One. 2008;3(8):e2679. https://doi.org/10.1371/journal.pone.0002679
behaviour, if practised widely, has the potential to undermine 5. Podder CN, Sharomi O, Gumel AB, Moses S. To cut or not to cut: A modeling
approach for assessing the role of male circumcision in HIV control. Bull Math Biol.
the public health benefits of VMMC. Instead, we found that 2007;69(8):2447–2466. https://doi.org/10.1007/s11538-007-9226-9
in the 3 months following VMMC, both the overall number 6. Nagelkerke NJ, Moses S, De Vlas SJ, Bailey RC. Modelling the public health impact
and timing of sexual partners were similar to pre-circumcision of male circumcision for HIV prevention in high prevalence areas in Africa. BMC
Infect Dis. 2007;7:16. https://doi.org/10.1186/1471-2334-7-16
levels. Botswana’s circumcision programme continues to 7. UNAIDS. Country factsheets: Botswana [homepage on the Internet]. 2017 [cited
provide HIV prevention through the circumcision procedure 2018 Aug 23]. Available from: http://www.unaids.org/en/regionscountries/
countries/botswana
itself and is not being jeopardised by the perception of 8. Williams BG, Gupta S, Wollmers M, Granich R. The impact and cost of ending AIDS
reduced risk of HIV acquisition. in Botswana. Lancet HIV. 2016;3(9):E409. https://doi.org/10.1016/S2352-3018
(16)30116-3
Acknowledgements 9. Bollinger LA, Stover J, Musuka G, Fidzani B, Moeti T, Busang L. The cost and impact
of male circumcision on HIV/AIDS in Botswana. J Int AIDS Soc. 2009;12(1):7.
https://doi.org/10.1186/1758-2652-12-7
Competing interests 10. Govender K, George G, Beckett S, Montague C, Frohlich J. Risk compensation
following medical male circumcision: Results from a 1-year prospective cohort
All authors declare that they have no financial or personal study of young school-going men in KwaZulu-Natal, South Africa. Int J Behav Med.
relationships that may have inappropriately influenced them 2018;25:123–130. https://doi.org/10.1007/s12529-017-9673-0
in writing this article. 11. Kankaka EN, Ssekasanvu J, Prodger J, et al. Sexual risk behaviors following
circumcision among HIV-positive men in Rakai, Uganda. AIDS Care. 2018;
30(8):990–996. https://doi.org/10.1080/09540121.2018.1437253
Authors’ contributions 12. Westercamp M, Jaoko W, Mehta S, Abuor P, Siambe P, Bailey R. Changes in male
circumcision prevalence and risk compensation in the Kisumu, Kenya population
2008–2013. J Acquir Immune Defic Syndr. 2017;74(2):e30–e37. https://doi.
L.P.S. and K.E.H. conceived of the presented idea and org/10.1097/QAI.0000000000001180
performed the analysis and wrote the manuscript. S.M. and 13. Mukudu H, Dietrich J, Otwombe K, et al. Voluntary medical male circumcision
S.B. verified the analytical methods and edited the final (VMMC) for prevention of heterosexual transmission of HIV and risk compensation
in adult males in Soweto: Findings from a programmatic setting. PLoS One.
manuscript. J.H.L. supervised the findings of this work and 2019;14(3):e0213571. https://doi.org/10.1371/journal.pone.0213571
edited the final manuscript. All authors discussed the results 14. Ortblad KF, Harling G, Chimbindi N, Tanser F, Salomon JA, Barnighausen T. Does
and contributed to the final manuscript. incident circumcision lead to risk compensation? Evidence from a population
cohort in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2019;
80(3):269–275. https://doi.org/10.1097/QAI.0000000000001912
Funding information 15. Makhema J, Wirth KE, Pretorius Holme M, et al. Universal testing, expanded
treatment, and incidence of HIV infection in Botswana. N Engl J Med.
2019;381:230–242. https://doi.org/10.1056/NEJMoa1812281
This publication was made possible by grant number 16. Ministry of Health. Safe male circumcision: Additional strategy for HIV prevention:
U91HA06801 from the U.S. Department of Health and Human A national strategy. Gaborone: Ministry of Health; 2010.
Services, Health Resources and Services Administration, 17. Connor RJ. Sample size for testing differences in proportions for the paired-
sample design. Biometrics. 1987;43(1):207–211. https://doi.org/10.2307/2531961
HIV/AIDS Bureau’s Global Health Systems Branch and grant
18. Ho-Foster A, Laetsang D, Masisi M, et al. Gender-specific patterns of multiple
number UL1TR000423 from the National Center for Research concurrent sexual partnerships: A national cross-sectional survey in Botswana.
Resources, National Institutes of Health. Its contents are solely AIDS Care. 2010;22(8):1006–1011. https://doi.org/10.1080/09540121003758598
the responsibility of the authors and do not necessarily 19. Eaton LA, Cain DN, Agrawal A, Jooste S, Udemans N, Klichman SC. The influence of
male circumcision for HIV prevention on sexual behavior among traditionally
represent the official views of the government. circumcised men in Cape Town, South Africa. Int J STD AIDS. 2011;22(11):
674–679. https://doi.org/10.1258/ijsa.2011.011006
20. Harris PA, Taylor R, Thielke, JP, Payne J, Gonzalez N, Conde JG. Research electronic
Data availability statement data capture (REDCap) – A metadata-driven methodology and workflow process
for providing translational research informatics support. J Biomed Inform.
2009;42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010
The computing code and an anonymised analytic data set 21. UNAIDS reference group on estimates, modelling and projections: Working group
used to produce the results contained in this manuscript on measuring concurrent sexual partnerships. HIV: Consensus indicators are
are available upon request from the corresponding author. needed for concurrency. Lancet. 2009;375(9715):621–622. https://doi.org/
10.1016/S0140-6736(09)62040-7
http://www.sajhivmed.org.za 153 Open Access