1 / 13

Current MC Related Research

This research program in Rakai, Uganda focuses on studying the community effects of male circumcision (MC) on the HIV epidemic through nested clinical research. It includes studies on HIV acquisition/transmission, STIs, sexual behaviors, mucosal immunology, and the potential role of genital micro-biota and inflammation.

galloways
Download Presentation

Current MC Related Research

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Current MC Related Research 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. Running MC related grants • Community Effects of MC on HIV Epidemic with Nested Clinical Research • HIV, STIs, and behaviors in a RCT & post-Trial Surveillance • In Situ analysis of HIV transmission in foreskin & • HPV Testing Supplements • Genital anaerobes, inflammation and HIV risk, Rakai

  3. Rakai District; South Western Uganda Rakai Cohort Annual Surveillance N=15000 Age 15-49 A community hub where men are seen for their post trial follow up visits

  4. Community Effects of MC on HIV Epidemic with Nested Clinical Research • Post Trial community Surveillance • Acceptance, Behavior, HIV Acquisition/Transmission • Impact at Individual & Population level • Relevant Clinical Research • Healing by HIV status • Surgical stress on HIV viral load • HIV shedding from surgical wound • Foreskin Inflammation and mucosal Immunology studies • Mucosal Barriers and susceptibility to HIV • Mucosal Immunological and inflammatory characteristics in HIV- men with and without HIV exposure

  5. Sexual Behavior in Post trial surveillance(interim analyses) 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. HIV, STIs, and behaviors in the trial and post trial • Long term follow up • Effectiveness of Circ on HIV/STI prevention • Effect of Circ on sexual behaviors • MC and STI Prevention • STI assays on stored trial samples

  7. HIV, STIs, and Behaviors in the RCT & post-RCT Surveillance Transmission in the foreskin supplement • Earliest events and virus-host cell interactions in HIV transmission • New HIV Sero-positive • New PCR+ but Sero-negative • To determine basis for low F M transmission using foreskin studies of HIV- men in discordant relationships n=50

  8. HIV, STIs, and Behaviors in the RCT & post-RCT Surveillance HPV testing supplement To assess efficacy of MC for HR HPV prevention in HIV+ and HIV- men To assess efficacy of MC in preventing HR HPV in female partners of HIV+ and HIV- men

  9. MC and STI; recent findings

  10. Genital anaerobes, inflammation and HIV risk, Rakai • Correlation between the burden of genital anaerobes and inflammatory markers in HIV uninfected men and their female partners • Association Genital anaerobes, Inflammatory markers and risk of HIV acquisition/transmission • Estimate role of genital anaerobes and inflammation in the efficacy of MC

  11. 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 Preparing the prepuce for storage Focal Inflammation in the Foreskin (left) and densities of CD4 and CD8 cells (lower panel) n NMDS plot of penile microbiota before surgery and at follow up post surgery

  12. Summary Studies on Long term efficacy of MC Community level effectiveness of MC on HIV/STI prevention Effect of MC on sexual behavior Mucosal Immunological studies The potential mediating role of genital micro-biota and inflammation in efficacy of MC

  13. ACKNOWLEDGEMENT • Research Grants • NIAID • Bill & Melinda Gates Foundation • Circumcision Service & Provider Training • PEPFAR

More Related