Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention
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Case Western Reserve University School of Graduate Studies / OhioLINK
2014
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| Online Access: | http://rave.ohiolink.edu/etdc/view?acc_num=case1393439536 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-case13934395362021-08-03T06:22:36Z Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention Kagaayi, Joseph Epidemiology Health Public Health Biostatistics Biomedical Research Indices HIV risk prediction circumcision services Objectives: (i)To derive indices to predict the risk of HIV acquisition in Rakai, Uganda. (ii)To determine whether HIV risk profiles differed between acceptors of safe male circumcision (SMC) and non-acceptors before and after SMC. MethodsDerivation of indicesWe used data on 7,497 women and 5,783 men from the Rakai community cohort study (RCCS). Multivariable Cox proportional hazards models were used to estimate time-to-HIV infection associated with candidate predictors. Model discrimination was determined using Harrell’s concordance index (c-index). Model calibration was determined graphically. Comparison of SMC acceptors and non-acceptorsWe compared HIV risk scores and behaviors of 1192 SMC acceptors and 2384 non-acceptors prior to SMC and at two subsequent RCCS survey visits. ResultsDerivation of indicesA total of 342 and 225 new infections occurred among females and males respectively. The final models’ c-indices were 69.1 percent (95 % CI=0.66-0.73); and 0.67 (95 % CI=0.64- 0.70) for men and women respectively. Models were well calibrated.Comparison of SMC acceptors and non-acceptorsCompared to non-acceptors, HIV-risk scores were 6.4 points higher (p<0.001) among SMC acceptors prior to SMC and acceptors were 33.5 percent more likely to report genital ulcers (GUD). Comparing acceptors to non-acceptors, risk scores declined by 12.4 points more per visit (p<0.001) and GUD prevalence declined by 29.4 percent more per visit (p=0.011) after SMC. After SMC, condom use at last sex did not change among acceptors but reduced by 13 percent (p=0.002) per visit among non-acceptors. After SMC, partnerships with women in high-risk occupations increased by 13 percent per visit among acceptors (p=0.046), but no change among non-acceptors and the rate sexual debut was 5 percent higher among SMC acceptors. ConclusionIndices were discriminative and well calibrated and using them to compare SMC acceptors and non-acceptors showed that sexually active SMC acceptors were at higher risk for HIV prior to SMC. After SMC, acceptors had a faster decline in HIV risk scores and were more likely to use condoms. These findings suggest that SMC programs are likely to be effective. However, there is need to emphasize avoidance of high-risk partners and delaying of sexual debut. 2014-06-11 English text Case Western Reserve University School of Graduate Studies / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=case1393439536 http://rave.ohiolink.edu/etdc/view?acc_num=case1393439536 unrestricted This thesis or dissertation is protected by copyright: some rights reserved. It is licensed for use under a Creative Commons license. Specific terms and permissions are available from this document's record in the OhioLINK ETD Center. |
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NDLTD |
| language |
English |
| sources |
NDLTD |
| topic |
Epidemiology Health Public Health Biostatistics Biomedical Research Indices HIV risk prediction circumcision services |
| spellingShingle |
Epidemiology Health Public Health Biostatistics Biomedical Research Indices HIV risk prediction circumcision services Kagaayi, Joseph Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention |
| author |
Kagaayi, Joseph |
| author_facet |
Kagaayi, Joseph |
| author_sort |
Kagaayi, Joseph |
| title |
Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention |
| title_short |
Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention |
| title_full |
Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention |
| title_fullStr |
Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention |
| title_full_unstemmed |
Indices to Predict the Risk of HIV in Rakai, Uganda: Application to the Scale-up of Safe Male Circumcision for HIV Prevention |
| title_sort |
indices to predict the risk of hiv in rakai, uganda: application to the scale-up of safe male circumcision for hiv prevention |
| publisher |
Case Western Reserve University School of Graduate Studies / OhioLINK |
| publishDate |
2014 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=case1393439536 |
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