Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial
TL;DR: In this article, a randomised controlled trial of 2784 men aged 18-24 years in Kisumu, Kenya was conducted to determine whether male circumcision had a protective effect against HIV infection, and to assess safety and changes in sexual behaviour related to this intervention.
About: This article is published in The Lancet.The article was published on 2007-02-24. It has received 2075 citations till now. The article focuses on the topics: Circumcision and HIV & Population.
Citations
More filters
University of Colorado Denver1, University of California, San Francisco2, Asociación Civil Impacta Salud y Educación3, Oswaldo Cruz Foundation4, Chiang Mai University5, Federal University of Rio de Janeiro6, University of Cape Town7, Brown University8, University of São Paulo9, National Institutes of Health10
TL;DR: Oral FTC-TDF provided protection against the acquisition of HIV infection among the subjects and Detectable blood levels strongly correlated with the prophylactic effect.
Abstract: The study subjects were followed for 3324 person-years (median, 1.2 years; maximum, 2.8 years). Of these subjects, 10 were found to have been infected with HIV at en rollment, and 100 became infected during follow-up (36 in the FTC–TDF group and 64 in the placebo group), indicating a 44% reduction in the incidence of HIV (95% confidence interval, 15 to 63; P = 0.005). In the FTC–TDF group, the study drug was detected in 22 of 43 of seronegative subjects (51%) and in 3 of 34 HIV-infected subjects (9%) (P<0.001). Nausea was reported more frequently during the first 4 weeks in the FTC–TDF group than in the placebo group (P<0.001). The two groups had similar rates of serious adverse events (P = 0.57). Conclusions Oral FTC–TDF provided protection against the acquisition of HIV infection among the subjects. Detectable blood levels strongly correlated with the prophylactic effect. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foun dation; ClinicalTrials.gov number, NCT00458393.)
4,247 citations
TL;DR: The use of effect size reporting in the analysis of social science data remains inconsistent and interpretation of the effect size estimates continues to be confused as discussed by the authors, and clinicians also may have little guidance in the interpretation of effect sizes relevant for clinical practice.
Abstract: Increasing emphasis has been placed on the use of effect size reporting in the analysis of social science data. Nonetheless, the use of effect size reporting remains inconsistent, and interpretation of effect size estimates continues to be confused. Researchers are presented with numerous effect sizes estimate options, not all of which are appropriate for every research question. Clinicians also may have little guidance in the interpretation of effect sizes relevant for clinical practice. The current article provides a primer of effect size estimates for the social sciences. Common effect sizes estimates, their use, and interpretations are presented as a guide for researchers.
2,680 citations
TL;DR: Tenofovir in a vaginal gel formulation shows significant protection against HIV infection in a randomized control trial, and could potentially fill an important HIV prevention gap, especially for women unable to successfully negotiate mutual monogamy or condom use.
Abstract: The Centre for the AIDS Program of Research in South Africa (CAPRISA) 004 trial assessed the effectiveness and safety of a 1% vaginal gel formulation of tenofovir, a nucleotide reverse transcriptase inhibitor, for the prevention of HIV acquisition in women. A double-blind, randomized controlled trial was conducted comparing tenofovir gel (n = 445 women) with placebo gel (n = 444 women) in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural KwaZulu-Natal, South Africa. HIV serostatus, safety, sexual behavior, and gel and condom use were assessed at monthly follow-up visits for 30 months. HIV incidence in the tenofovir gel arm was 5.6 per 100 women-years (person time of study observation) (38 out of 680.6 women-years) compared with 9.1 per 100 women-years (60 out of 660.7 women-years) in the placebo gel arm (incidence rate ratio = 0.61; P = 0.017). In high adherers (gel adherence > 80%), HIV incidence was 54% lower (P = 0.025) in the tenofovir gel arm. In intermediate adherers (gel adherence 50 to 80%) and low adherers (gel adherence < 50%), the HIV incidence reduction was 38 and 28%, respectively. Tenofovir gel reduced HIV acquisition by an estimated 39% overall, and by 54% in women with high gel adherence. No increase in the overall adverse event rates was observed. There were no changes in viral load and no tenofovir resistance in HIV seroconverters. Tenofovir gel could potentially fill an important HIV prevention gap, especially for women unable to successfully negotiate mutual monogamy or condom use.
2,365 citations
TL;DR: Male circumcision reduced HIV incidence in men without behavioural disinhibition as well as in all sociodemographic, behavioural, and sexually transmitted disease symptom subgroups.
2,034 citations
TL;DR: These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013.
Abstract: These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
1,862 citations
References
More filters
TL;DR: In this article, the product-limit (PL) estimator was proposed to estimate the proportion of items in the population whose lifetimes would exceed t (in the absence of such losses), without making any assumption about the form of the function P(t).
Abstract: In lifetesting, medical follow-up, and other fields the observation of the time of occurrence of the event of interest (called a death) may be prevented for some of the items of the sample by the previous occurrence of some other event (called a loss). Losses may be either accidental or controlled, the latter resulting from a decision to terminate certain observations. In either case it is usually assumed in this paper that the lifetime (age at death) is independent of the potential loss time; in practice this assumption deserves careful scrutiny. Despite the resulting incompleteness of the data, it is desired to estimate the proportion P(t) of items in the population whose lifetimes would exceed t (in the absence of such losses), without making any assumption about the form of the function P(t). The observation for each item of a suitable initial event, marking the beginning of its lifetime, is presupposed. For random samples of size N the product-limit (PL) estimate can be defined as follows: L...
52,450 citations
TL;DR: In this article, an extension of generalized linear models to the analysis of longitudinal data is proposed, which gives consistent estimates of the regression parameters and of their variance under mild assumptions about the time dependence.
Abstract: SUMMARY This paper proposes an extension of generalized linear models to the analysis of longitudinal data. We introduce a class of estimating equations that give consistent estimates of the regression parameters and of their variance under mild assumptions about the time dependence. The estimating equations are derived without specifying the joint distribution of a subject's observations yet they reduce to the score equations for multivariate Gaussian outcomes. Asymptotic theory is presented for the general class of estimators. Specific cases in which we assume independence, m-dependence and exchangeable correlation structures from each subject are discussed. Efficiency of the proposed estimators in two simple situations is considered. The approach is closely related to quasi-likelih ood. Some key ironh: Estimating equation; Generalized linear model; Longitudinal data; Quasi-likelihood; Repeated measures.
17,111 citations
01 Jan 1972
TL;DR: The drum mallets disclosed in this article are adjustable, by the percussion player, as to balance, overall weight, head characteristics and tone production of the mallet, whereby the adjustment can be readily obtained.
Abstract: The drum mallets disclosed are adjustable, by the percussion player, as to weight and/or balance and/or head characteristics, so as to vary the "feel" of the mallet, and thus also the tonal effect obtainable when playing upon kettle-drums, snare-drums, and other percussion instruments; and, typically, the mallet has frictionally slidable, removable and replaceable, external balancing mass means, positionable to serve as the striking head of the mallet, whereby the adjustment as to balance, overall weight, head characteristics and tone production may be readily obtained. In some forms, the said mass means regularly serves as a removable and replaceable striking head; while in other forms, the mass means comprises one or more thin elongated tubes having a frictionally-gripping fit on an elongated mallet body, so as to be manually slidable thereon but tight enough to avoid dislodgment under normal playing action; and such a tubular member may be slidable to the head-end of the mallet to serve as a striking head or it may be slidable to a position to serve as a hand grip; and one or more such tubular members may be placed in various positions along the length of the mallet. The mallet body may also have a tapered element at the head-end to assure retention of mass members especially of enlarged-head types; and the disclosure further includes such heads embodying a relatively hard inner portion and a relatively soft outer covering.
10,148 citations
TL;DR: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved in sub-Saharan Africa.
Abstract: Background Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. Methods and Findings A total of 3,274 uncircumcised men, aged 18–24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR) of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 � RR. The trial was stopped at the interim analysis, and the mean (interquartile range) follow-up was 18.1 mo (13.0–21.0) when the data were analyzed. There were 20 HIV infections (incidence rate ¼0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%–0.68%; p , 0.001). This RR corresponds to a protection of 60% (95% CI: 32%–76%). When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%– 77%).
2,483 citations
TL;DR: Male circumcision reduced HIV incidence in men without behavioural disinhibition as well as in all sociodemographic, behavioural, and sexually transmitted disease symptom subgroups.
2,034 citations