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Elijah Odoyo-June 1,3 , John Rogers 2 , Walter Jaoko 1,3 , Robert C. Bailey 1, 2

Wound healing and resumption of sex following medical circumcision of adult males in Kisumu , Kenya. Elijah Odoyo-June 1,3 , John Rogers 2 , Walter Jaoko 1,3 , Robert C. Bailey 1, 2 1 Nyanza Reproductive Health Society 2 University of Illinois at Chicago 3 University of Nairobi. Background.

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Elijah Odoyo-June 1,3 , John Rogers 2 , Walter Jaoko 1,3 , Robert C. Bailey 1, 2

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  1. Wound healing and resumption of sex following medical circumcision of adult males in Kisumu, Kenya Elijah Odoyo-June1,3, John Rogers2, Walter Jaoko1,3, Robert C. Bailey1, 2 1Nyanza Reproductive Health Society 2University of Illinois at Chicago 3University of Nairobi

  2. Background • Kenya launched VMMC in 2008 - >350,000 MC done to date • Resuming sex before complete wound healing may modify the relationship between circumcision and HIV • WHO recommends six-weeks sexual abstinence following MC but variation in time to healing and its determinants are not fully understood • Interim results of our study assessing time to wound healing and resumption of sex are presented here

  3. Assess time to complete wound healing in HIV+ and HIV- men Assess compliance with post-circumcision abstinence recommendations Identify factors associated with variation in wound healing Assess wound keratinization and it’s relationship with visible healing Determine effect of MC on CD4 count, plasma viral load, and viral shedding from incision site Objectives

  4. Study Site The study is being conducted in Kisumu, Kenya among men voluntarily seeking medical male circumcision services at UNIM clinic within Lumumba Health Centre

  5. Interviews at baseline and 8 follow-up visits Visual inspection of wound for apposition of edges, presence of gaps or disruptions, and scar formation Scar monitored for color progression on graduated scale from 1 to 15 Photographs of wound taken weekly for assessment of wound status by independent, blinded observer Methods Wk0 Wk1 Wk2 Wk3 Wk4 Wk5

  6. Study Population Characteristics

  7. Wound healing Assessed clinically on 5 level variable Collapsed into dichotomous outcome for this analysis (wound healing complete vs. not complete) Time to sex Assessed clinically using 2 questions asked at each follow up Have you had sexual intercourse with any person since circumcision? How long after circumcision did you first have sexual intercourse? Early sex: sex after circumcision before day of observed complete healing Primary Outcome Variables

  8. Time to Complete Wound Healing

  9. Time to Complete Healing

  10. Resumption of Sex RR = 1.84 95% CI = (0.92 – 3.69) RR = 1.86 95% CI = (0.96 – 3.60)

  11. 156 HIV-negative and 75 HIV-positive included – target sample size of 215 HIV-negative and 115 HIV-positive Wound healing is similar in HIV-negative & HIV-positive – largest difference in healing rates occurred at 4-weeks post-op 13.3% of men resumed sex before complete wound healing Married men may be more likely to engage in early sex (RR 1.84, 95%CI 0.92 – 3.69) Interim Results Summary

  12. Based on this interim analysis, the WHO recommendations for six weeks of post-circumcision abstinence should be maintained Consistent with recently published data from our group, there is indication that married men may be more likely to engage in early sex – these men and their partners should be targeted for special counseling concerning abstinence and condom use Conclusions

  13. Study participants UNIM Clinic study staff Nyanza Reproductive Health Society Male Circumcision Consortium Bill and Melinda Gates Foundation Acknowledgements

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