NRU :: Browsing by Author "Gray, Ronald H."

Browsing by Author "Gray, Ronald H."

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Age Differences in Sexual Partners and Risk of HIV-1 Infection in Rural Uganda
(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2003) Kelly, Robert J.; Gray, Ronald H.; Sewankambo, Nelson K.; Serwadda, David; Wabwire-Mangen, Fred; Lutalo, Tom; Wawer, Maria J.
Gender differentials in HIV prevalence and incidence among adolescents and young adults have been observed in studies from Uganda (Fig. 1) (1–4) and other sub- Saharan Africa countries (5–7). Female adolescents are, on average, eight times more likely to be HIV infected than male adolescents. Biologic mechanisms such as immaturity of the reproductive tract in younger women may increase susceptibility to HIV acquisition, and social and cultural practices that promote early sexual activity among women may also be important. Another hypothesized factor is that young women are infected by having sex with older men, who may be more likely to be infected (8–10). This assumption is supported by comparison of age-adjusted HIV prevalence data (4,5,11) and mathematic modeling (12,13). Few empiric studies have examined the effect of age differences between partners on the risk of HIV infection in young women, however (2,14,15). We undertook observational analyses of the sexual behavior characteristics of adolescents in Rakai District, Uganda, to assess the extent to which the age
Age of male circumcision and risk of prevalent HIV infection in rural Uganda
(Aids, 1999) Kelly, Robert; Kiwanuka, Noah; Wawer, Maria J.; Serwadda, David; Sewankambo, Nelson; Wabwire-Mangen, Fred; Li, Chuanjun; Konde-Lule, Joseph K.; Lutalo, Tom; Makumbi, Fred; Gray, Ronald H.
Epidemiological evidence suggests that male circumcision may reduce the risk of sexually transmitted diseases (STD) and possibly HIV infection. Studies of STD clinic attenders have found that circumcised men are less likely to have gonorrhea, syphilis, herpes, candidiasis, and genital ulcer disease (GUD) [1–3]. Age at circumcision has also been reported as a risk factor in penile cancer [4]. Ecological studies report geographic correlations between HIV seroprevalence and the proportion of uncircumcised men in African populations [5,6], but subsequent cross-sectional and prospective studies found an inconsistent association between male circumcision and HIV-1 and HIV-2 infection in men and women [7–9].
Age-Disparate Relationships and HIV Prevalence among Never Married Women in Rakai, Uganda
(Journal of acquired immune deficiency syndromes, 2018) Mwinnyaa, George; Gray, Ronald H.; Grabowski, Mary K.; Ssekasanvu, Joseph; Ndyanabo, Anthony; Ssekubugu, Robert; Kagaayi, Joseph; Kigozi, Godfrey; Nakigozi, Gertrude; Serwadda, David M.; Laeyendecker, Oliver
Age-disparate relationships are associated with increased HIV prevalence. We determined whether the frequency of age-disparate relationships in never married women changed over time and whether they are associated with HIV prevalence in Rakai, Uganda. Methods: 10,061 never married women, aged 15–49 in the Rakai Community Cohort Study provided information on the age of their male sexual partners from 1997 to 2013. Logistic regression was used to assess trends in age-disparate relationships (≥5 years) between never married women and their male partners. Log-binomial regression was used to estimate adjusted prevalence ratios (adjPR) of HIV prevalence associated with age-disparate relationships. Results: 2,992 women (30%) had a male partner ≥5 years older which remained stable over time. The prevalence of HIV among women in age-disparate relationships was 14%, 10% for women in relationships with men 0–4 years older (adjPR 1.36, 95% CI 1.22, 1.53) not controlling women’s age, however after age adjustment the impact of age-disparate relationships on HIV prevalence was attenuated. Age-disparate relationships were associated with increased HIV prevalence among women aged 15–17 (adjPR 1.83, 95% CI 1.10, 3.19), but not in other age groups. Conclusions: The frequency of age-disparate relationships among never married women were unchanged over a 15-year period in Rakai, Uganda. Age-disparate relationships were associated with increased HIV prevalence among adolescents 15–17, but not older women.
Alcohol use before sex and HIV acquisition: a longitudinal study in Rakai, Uganda
(Aids, 2006) Zablotska, Iryna B.; Gray, Ronald H.; Serwadda, David; Nalugoda, Fred; Kigozi, Godfrey; Sewankambo, Nelson; Lutalo, Tom; Wabwire-Mangen, Fred; Wawer, Maria
Alcohol abuse is a major public health problem and is associated with sexually transmitted infections, but the association with HIV is unclear [2]. Alcohol use is common, and disinhibition as a result of alcohol may precipitate and reinforce sexual risk-taking [2–13]. Two cross-sectional studies in Uganda have suggested associations between alcohol use, risk behaviors and prevalent HIV infection [12,14]. However, there are no prospective studies of alcohol use in conjunction with sex and HIV acquisition. We used data from a population based cohort in Rakai, Uganda, to determine whether alcohol use before sex was associated with the risk of HIV acquisition, and risk behaviors.
Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda
(AIDS and Behavior, 2009) Zablotska, Iryna B.; Gray, Ronald H.; Koenig, Michael A.; Serwadda, David; Nalugoda, Fred; Kigozi, Godfrey; Sewankambo, Nelson; Lutalo, Tom; Wabwire-Mangen, Fred; Wawer, Maria
Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15–24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06– 1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25–2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in
Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai,Uganda
(American Medical Association, 2016) Kong, Xiangrong; Kigozi, Godfrey; Ssekasanvu, Joseph; Nalugoda, Fred; Nakigozi, Gertrude; Ndyanabo, Anthony; Lutalo, Tom; Reynolds, Steven J.; Ssekubugu, Robert; Kagaayi, Joseph; Bugos, Eva; Chang, Larry W.; Nanlesta, Pilgrim; Mary, Grabowski; Berman, Amanda; Quinn, Thomas C.; Serwadda, David; Wawer, Maria J.; Gray, Ronald H.
Randomized trials have shown that medical male circumcision( MMC)reduces maleHIVacquisition by50% to 60%,1-3 and that early initiation of antiretroviral therapy (ART) reduces HIV transmission by more than90%in HIV-discordant couples.4Mathematical modeling suggests that these interventions could mitigate the HIV epidemic in sub- Saharan Africa,5-7 but there is limited empirical evidence for the population-level effects of these interventions on HIV incidence in real-world programs. MMC provides direct protection against male HIV acquisition by removing the foreskin, which is rich in HIV target cells.8-10 The potential effect ofMMCon population-level HIV incidence depends on this biological effect, the level ofMMC coverage, risk profiles ofmenacceptingMMC,and whether behavioral disinhibition occurs following circumcision.
Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda: A Cross Sectional Analysis of Longitudinal Data
(AIDS and Behavior, 2020) Nalugoda, Fred; Kreniske, Philip; Hofer, Sarah; Zhong, Xiaobo; Wei, Ying; Grilo, Stephanie A.; Chen, Ivy; D. Kigozi, Ssebaggala; Kigozi, Godfrey; Lutalo, Tom; Ssekubugu, Robert; Nakawooya, Hadijja; Kagaayi, Joseph; Chang, Larry W.; Wawer, Maria J.; Gray, Ronald H.; Wang, Qianshu; Santelli, John S.
Cell phones have increased communication and connection across the globe and particularly in sub-Saharan Africa—with potential consequences for the HIV epidemic. We examined the association among ownership of cell phones, sexual behaviors (number of sexual partners, alcohol use before sex, inconsistent condom use), and HIV prevalence. Data were from four rounds (2010–2016) of the Rakai Community Cohort Study (N = 58,275). Sexual behaviors and HIV prevalence were compared between people who owned a cell phone to people who did not own a cell phone. We stratified analysis by younger (15–24 years) and older (25+ years) age groups and by gender. Using logistic regression and after adjusting for sociodemographic characteristics, we found cell phone ownership was independently associated with increased odds of having two or more sexual partners in the past 12 months across age and gender groups (young men AOR 1.67, 95% CI 1.47–1.90; young women AOR 1.28 95% CI 1.08–1.53; older men AOR 1.54 95% CI 1.41–1.69; older women AOR 1.44 95% CI 1.26–1.65). Interestingly, young men who owned cell phones had decreased odds of using condoms inconsistently (AOR 0.66, 95% CI 0.57–0.75). For young women, cell phone ownership was associated with increased odds of using alcohol before sex (AOR 1.38 95% CI 1.17–1.63) and increased odds of inconsistent condom use (AOR 1.40, 95% 1.17–1.67). After adjusting for sociodemographic characteristics, only young women who owned cell phones had increased odds of being HIV positive (AOR 1.27 95% CI 1.07–1.50). This association was not mediated by sexual behaviors (Adjusted for sociodemographic characteristics and sexual behaviors AOR 1.24, 95% CI 1.05–1.46). While cell phone ownership appears to be associated with increased HIV risk for young women, we also see a potential opportunity for future cell phone-based health interventions.
Comparison of the penile microbiome in infant male circumcision: Mogen clamp versus Shangring
(Elsevier B.V, 2024-07) Salazar, Juan E; Park, Daniel E; Punjani, Nahid; Pham, Tony; Aziz, Maliha; Kigozi, Godfrey; Gray, Ronald H.; Kiboneka, Stephen D; Goldstein, Marc; Li, Philip S; Lee, Richard; Liu, Cindy M.
This study aimed to characterise the infant penile (coronal sulcus) microbiome and the effects of early infant male circumcision (EIMC), following a standard surgical method (Mogen Clamp) and a non-surgical alternative (ShangRing). We collected coronal sulcus swabs at baseline and on days 7 and 14 post-circumcision from infants assigned to receive EIMC by Mogen Clamp (n = 15) or ShangRing (n = 15), in a randomised trial in Rakai and Kakuuto, Uganda. We used 16S rRNA gene-based sequencing and broad-coverage qPCR to characterise the infant penile microbiome and assess the effects of EIMC in both study arms. Prior to EIMC, the infant penile microbiome had a mixture of facultative and strict anaerobes. In both study arms, EIMC caused penile microbiome proportional abundance changes characterised by decreases in penile anaerobes [ShangRing Prevotella: −15.0%, (SD = 19.1); Mogen clamp Prevotella: −3.6% (11.2); ShangRing Veillonella: −11.3% (17.2); Mogen clamp Veillonella: −2.6% (11.8)] and increases in skin-associated facultative anaerobes [ShangRing Corynebacterium: 24.9%, (22.4); Mogen clamp Corynebacterium: 4.7% (21.3); ShangRing Staphylococcus: 21.1% (20.5); Mogen clamp Staphylococcus: 18.1% (20.1)]. Clostridium tetani was not detected during the study. Mogen Clamp and ShangRing EIMC both changed the composition of the infant penile microbiome by reducing the proportional abundances of anaerobes and uropathogens, which is consistent with medical male circumcision findings in adults. C. tetani was not increased by either EIMC method. Bill and Melinda Gates Foundation.
Contextual Barriers and Motivators to Adult Male Medical Circumcision in Rakai, Uganda
(Qualitative health research, 2013) Ssekubugu, Robert; Leontsini, Elli; Wawer, Maria J.; Serwadda, David; Kigozi, Godfrey; Kennedy, Caitlin E.; Nalugoda, Fred; Sekamwa, Richard; Wagman, Jennifer; Gray, Ronald H.
Medical male circumcision (MMC) is a central component of HIV prevention. In this study we examined barriers to and facilitators of MMC in Rakai, Uganda. Interviews and focus groups with MMC acceptors, decliners, and community members were collected and analyzed iteratively. Themes were developed based on immersion, repeated reading, sorting, and coding of data using grounded theory. Pain, medical complications, infertility, lack of empirical efficacy, waiting time before resumption of sex, and religion were identified as obstacles to MMC acceptance. Prevention and healing of sexually transmitted infections (STIs), access to HIV and other ancillary care, penile hygiene, and peer influence were key motivators. Voluntary counseling and testing for HIV, partner influence, and sexual potency were both barriers and motivators. Individual and societal factors, such as pain and religion, might slow MMC scale up. Health benefits, such as HIV/STI prevention and penile hygiene, are essential in motivating men to accept MMC.
Designing and Usage of a Low-cost Penile Model for Male Medical Circumcision Skills Training in Rakai, Uganda
(Urology, 2011) Kigozi, Godfrey; Nkale, James; Wawer, Maria; Anyokorit, Margaret; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Kiwanuka, Noah; Mwinike, Joshua; Kighoma, Nehemiah; Nalwoga, Grace K.; Nakigozi, Gertrude F.; Katwalo, Henry; Serwadda, David; Gray, Ronald H.
To describe the designing and usage of a locally made low-cost penile model used for male medical circumcision (MMC) skills training. The Rakai MMC training team has experienced a number of challenges during conduct of MMC skills training, one of which was the lack of a model to use for MMC skills training. To address this challenge, the Rakai MMC skills training team has designed and developed a low-cost penile model for use in MMC skills training. The model has been successfully used to demonstrate external penile anatomy, to describe the biological mechanisms through which male circumcision (MC) prevents HIV acquisition, and for demonstration and practice of the MMC procedures. With an initial cost of only $10 and a recurrent cost of $5, this is a cost-efficient and useful penile model that provides a simulation of normal penile anatomy for use in MC training in resource limited settings. It has also been used as a visual aid in preoperative education of patients before receiving male circumcision. The model can be improved and scaled up to develop cheaper commercial penile models.
Determinants of HIV-1 Load in Subjects with Early and Later HIV Infections, in a General-Population Cohort of Rakai, Uganda
(Journal of Infectious Diseases, 2004) Gray, Ronald H.; Li, X.; Wawer, Maria J.; Serwadda, David; Sewankambo, Nelson K.; Wabwire-Mangen, Fred; Lutalo, Tom; Kiwanuka, Noah; Kigozi, Godfrey; Nalugoda, Fred; Meehan, Mary P.; Quinn, Thomas C.
Human immunodeficiency virus (HIV) type 1 RNA loads were determined for 256 subjects with early (incident) HIV infection and for 1293 subjects with later (prevalent) HIV infection, in a Ugandan cohort. Prevalent infections were classified as latent (0–1 symptoms) and midstage disease ( 2 symptoms), and deaths were ascribed to acquired immunodeficiency syndrome. Among subjects with incident HIV infection, HIV load did not differ by sex, but, among subjects with prevalent HIV infection, it was higher in males than in females. HIV load was highest in subjects (25–29 years old) with incident HIV infection but increased with age in subjects with prevalent HIV infection. Viremia was higher after serconversion than in latency and increased with more advanced disease. Viremia was increased with genital ulcer disease (GUD) in both subjects with incident infection and in those with prevalent infection, and with herpes simplex virus type 2 seropositivity in subjects with incident HIV infection. GUD was consistently associated with higher HIV loads in subjects with incident and those with prevalent HIV infection, suggesting that treatment of GUD might reduce HIV viremia.
The Effect of Antiretroviral Therapy Initiation on the Vaginal Microbiome in HIV-Infected Women
(The Journal of infectious diseases, 2021) Liu, Cindy M.; Packman, Zoe R.; Abraham, Alison G.; Serwadda, David M.; Nalugoda, Fred; Aziz, Maliha; Prodger, Jessica L.; Kaul, Rupert; Kalibbala, Sarah; Gray, Ronald H.; Price, Lance B.; Quinn, Thomas C.; Tobian, Aaron A.R.; Reynolds, Steven J.
The impact of antiretroviral therapy (ART) initiation on the vaginal microbiome is unknown. This is of particular importance among women living in sub-Saharan Africa. Understanding this relationship could help elucidate if and how the host immune system interacts with the vaginal microbiome. Methods. The vaginal microbiome of HIV-1/HSV-2-coinfected women (n = 92) in Uganda was evaluated from self-collected vaginal swabs 1 month pre-ART and at 4 and 6 months post–ART initiation. The vaginal microbiome was characterized by 16S rRNA genebased sequencing and quantitative polymerase chain reaction. Vaginal community state types (CSTs) were identified using proportional abundance data. Changes in microbiome composition were assessed with permutational analyses of variance (PerMANOVA).
Effect of Peer Health Workers on AIDS Care in Rakai, Uganda: A Cluster-Randomized Trial
(PloS one, 2010) Chang, Larry W.; Kagaayi, Joseph; Nakigozi, Gertrude; Ssempijja, Victor; Packer, Arnold H.; Serwadda, David; Quinn, Thomas C.; Gray, Ronald H.; Bollinger, Robert C.; Reynolds, Steven J.
Human resource limitations are a challenge to the delivery of antiretroviral therapy (ART) in low-resource settings. We conducted a cluster randomized trial to assess the effect of community-based peer health workers (PHW) on AIDS care of adults in Rakai, Uganda. Methodology/Principal Findings: 15 AIDS clinics were randomized 2:1 to receive the PHW intervention (n = 10) or control (n = 5). PHWtasks included clinic and home-based provision of counseling, clinical, adherence to ART, and social support. Primary outcomes were adherence and cumulative risk of virologic failure (.400 copies/mL). Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART. Analysis was by intention to treat. FromMay 2006 to July 2008, 1336 patients were followed. 444 (33%) of these patients were already on ART at the start of the study. No significant differences were found in lack of adherence (,95% pill count adherence risk ratio [RR] 0.55, 95% confidence interval [CI] 0.23–1.35; ,100% adherence RR 1.10, 95% CI 0.94–1.30), cumulative risk of virologic failure (RR 0.81, 95% CI 0.61–1.08) or in shorter-term virologic outcomes (24 week virologic failure RR 0.93, 95% CI 0.65–1.32; 48 week, RR 0.83, 95% CI 0.47–1.48; 72 week, RR 0.81, 95% CI 0.44–1.49). However, virologic failure rates$96 weeks into ART were significantly decreased in the intervention armcompared to the control arm (96 week failure RR 0.50, 95% CI 0.31–0.81; 120 week, RR 0.59, 95% CI 0.22–1.60; 144 week, RR 0.39, 95% CI 0.16–0.95; 168 week, RR 0.30, 95% CI 0.097–0.92; 192 week, RR 0.067, 95% CI 0.0065–0.71). Conclusions/Significance: A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART, but did not affect cumulative risk of virologic failure, adherence measures, or shorter-term virologic outcomes. PHWs may be an effective intervention to sustain long-term ART in low-resource settings
Effectiveness of Voluntary Medical Male Circumcision for Human Immunodeficiency Virus Prevention in Rakai, Uganda
(Clinical Infectious Diseases, 2021) Loevinsohn, Gideon; Kigozi, Godfrey; Kagaayi, Joseph; Wawer, Maria J.; Nalugoda, Fred; Chang, Larry W.; Quinn, Thomas C.; Serwadda, David; Reynolds, Steven J.; Nelson, Lisa; Mills, Lisa; Alamo, Stella; Nakigozi, Gertrude; Kabuye, Geoffrey; Ssekubugu, Robert; Tobian, Aaron A. R.; Gray, Ronald H.; Grabowski, M. Kathryn
The efficacy of voluntary male medical circumcision (VMMC) for human immunodeficiency virus (HIV) prevention in men was demonstrated in 3 randomized trials. This led to the adoption of VMMC as an integral component of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) combination HIV prevention program in sub-Saharan Africa. However, evidence on the individual-level effectiveness of VMMC programs in real-world, programmatic settings is limited. A cohort of initially uncircumcised, non-Muslim, HIV-uninfected men in the Rakai Community Cohort Study in Uganda was followed between 2009 and 2016 during VMMC scale-up. Self-reported VMMC status was collected and HIV tests performed at surveys conducted every 18 months. Multivariable Poisson regression was used to estimate the incidence rate ratio (IRR) of HIV acquisition in newly circumcised vs uncircumcised men.
The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda
(American journal of obstetrics and gynecology, 2009) Gray, Ronald H.; Kigozi, Godfrey; Serwadda, David; Makumbi, Fredrick; Nalugoda, Fred; Watya, Stephen; Moulton, Laurence; Cheng, Michael Z.; Sewankambo, Nelson K.; Kiwanuka, Noah; Sempijja, Victor; Lutalo, Tom; Kagayii, Joseph; Wabwire-Mangen, Fred; Ridzon, Renée; Bacon, Melanie; Wawer, Maria J.
The objective of the study was to assess effects of male circumcision on female genital symptoms and vaginal infections. STUDY DESIGN: Human immunodeficiency virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs) were assessed by multivariable log-binomial regression, intent-to-treat analyses. RESULTS: A total of 783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, P .001). At 1 year follow-up, intervention arm wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05- 0.98), as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk ratios, 0.39; 95% CI, 0.24-0.64). CONCLUSION: Male circumcision reduces the risk of ulceration, trichomonas, and BV in female partners.
Efficacy of Knowledge and Competence-Based Training of Non-Physicians in the Provision of Early Infant Male Circumcision using the Mogen Clamp in Rakai, Uganda
(BJU international, 2017) Kankaka, Edward Nelson; Kigozi, Godfrey; Kayiwa, Daniel; Kighoma, Nehemiah; Makumbi, Frederick; Murungi, Teddy; Nabukalu, Dorean; Nampijja, Resty; Watya, Stephen; Namuguzi, Daniel; Nalugoda, Fred; Nakigozi, Gertrude; Serwadda, David; Wawer, Maria; Gray, Ronald H.
To assess acquisition of knowledge and competence in performing Early Infant Male Circumcision (EIMC) by non-physicians trained using a structured curriculum.Training in provision of EIMC using the Mogen clamp was conducted for 10 Clinical Officers (COs) and 10 Registered Nurse Midwives (RNMWs), in Rakai, Uganda. Healthy infants whose mothers consented to study participation were assigned to the trainees, each of whom performed at least 10 EIMCs. Ongoing assessment and feedback for competency were done, and safety assessed by adverse events.Despite similar baseline knowledge, COs acquired more didactic knowledge than RNMWs (P = 0.043). In all, 100 EIMCs were assessed for gain in competency. The greatest improvement in competency was between the first and third procedures, and all trainees achieved 80% competency and retention of skills by the seventh procedure. The median (interquartile range) time to complete a procedure was 14.5 (10-47) min for the COs, and 15 (10-50) min for the RNMWs (P = 0.180). The procedure times declined by 2.2 min for each subsequent EIMC (P = 0.005), and rates of improvement were similar for COs and RNMWs. Adverse events were comparable between providers (3.5%), of which 1% were of moderate severity.Competence-based training of non-physicians improved knowledge and competency in EIMC performed by COs and RNMWs in Uganda.
Enhancers and barriers to uptake of male circumcision services in Northern Uganda: a qualitative study
(AIDS care, 2020) Nanteza, Barbara M.; Makumbi, Fredrick E.; Gray, Ronald H.; Serwadda, David; Kennedy, Caitlin E.
Uganda adopted voluntary medical male circumcision (VMMC) in 2010, but uptake remains disproportionately low in the Northern region despite implementing several demand creation strategies. This study explored the socio-cultural and structural enhancers and barriers to uptake of VMMC services in Gulu, a district in Northern Uganda where uptake is lowest. In September 2016, we conducted 19 focus group discussions, 9 in-depth interviews, and 11 key informant interviews with 149 total participants. Data were collected and analyzed thematically using both inductive and deductive approaches, then framed in four levels of the social ecological model. Enhancers included adequate knowledge about VMMC services, being young and single, partner involvement, peer influence, perceived increased libido after circumcision, and availability of free and high-quality VMMC services. Barriers included sexual abstinence during wound healing, penile appearance after circumcision, religion, culture, and misconceptions. Optimizing enhancers and addressing barriers could increase VMMC service uptake in northern Uganda.
Evaluation of current rapid HIV test algorithms in Rakai, Uganda
(Journal of virological methods, 2013) Galiwango, Ronald M.; Musoke, Richard; Lubyayi, Lawrence; Ssekubugu, Robert; Kalibbala, Sarah; Ssekweyama, Viola; Mirembe, Viola; Nakigozi, Gertrude; Reynolds, Steven J.; Serwadda, David; Gray, Ronald H.; Kigozi, Godfrey
Rapid HIV tests are a crucial component of HIV diagnosis in resource limited settings. In Uganda, the Ministry of Health allows for both serial and parallel HIV rapid testing using Determine, Stat- Pak and Uni-Gold. In serial testing, a non-reactive result on Determine ends testing. The performance of serial and parallel algorithms with Determine and Stat-Pak test kits was assessed. A cross-sectional diagnostic test accuracy evaluation using three rapid HIV test kits as per the recommended parallel test algorithm was followed by EIA-WB testing with estimates of the performance of serial testing algorithm. In 2520 participants tested by parallel rapid algorithms, 0.6% had weakly reactive result. Parallel testing had 99.7% sensitivity and 99.8% specificity. If Stat-Pak was used as the first screening test for a serial algorithm, the sensitivity was 99.6% and specificity 99.7%. However, if Determine was used as the screening test, sensitivity was 97.3% and specificity 99.9%. Serial testing with Stat-Pak as the initial screening test performed as well as parallel testing, but Determine was a less sensitive screen. Serial testing could be cost saving.
Evaluation of the Safety and Efficiency of the Dorsal Slit and Sleeve Methods of Male Circumcision Provided by Physicians and Clinical Officers in Rakai, Uganda
(BJU international, 2012) Buwembo, Dennis; Musoke, Richard; Kigozi, Godfrey; Sempijja, Victor; Serwadda, David; Makumbi, Frederick; Watya, Stephen; Namuguzi, Dan; Nalugoda, Fred; Kiwanuka, Noah; Sewankambo, Nelson K.; Mangen, Fred Wabwire; Lutalo, Tom; Kiggundu, Valerian; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemia; Wawer, Maria J.; Gray, Ronald H.
To assess safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers.We evaluated the time required for surgery and moderate / severe adverse events (AEs), among circumcisions by trained physicians and clinical officers using sleeve and dorsal slit methods. Univariate and multivariate regression with robust variance was used to assess factors associated with time for surgery (linear regression) and adverse events (logistic regression). Six physicians and 8 clinical officers conducted 1934 and 3218 MCs, respectively. There were 2471 dorsal slit and 2681 sleeve procedures. The mean duration of surgery was 33 minutes for newly trained providers and decreased to ~20 minutes after ~100 circumcisions. The adjusted mean duration of surgery for dorsal slit was significantly shorter than that for sleeve method (Δ −2.8 minutes, p- <0.001). The duration of surgery was longer for clinical officers than physicians performing the sleeve procedure, but not the dorsal slit procedure. Crude AEs rates were 0.6% for dorsal slit and 1.4% with the sleeve method (p=0.006). However, there were no significant differences after multivariate adjustment. Use of cautery significantly reduced time needed for surgery (Δ − 4.0 minutes, p =0.008), but was associated with higher rates of AEs (adjusted odds ratio 2.13, 95%CI 1.26–3.61, p=0.005).The dorsal slit resection method of male circumcision is faster and safer than sleeve resection, and can be safely performed by non-physicians. However, use of cautery may be inadvisable in this setting.
Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters)
(AIDS (London, England), 2009) Kigozi, Godfrey; Wawer, Maria; Ssettuba, Absalom; Kagaayia, Joseph; Nalugodaa, Fred; Watyad, Stephen; Wabwire Mangenc, Fred; Kiwanuka, Noah; Bacon, Melanie C.; Lutalo, Tom; Serwadda, David; Gray, Ronald H.
Male circumcision reduces HIV acquisition in men. We assessed whether foreskin surface area was associated with HIV acquisition prior to circumcision. In two randomized trials of male circumcision, the surface area of the foreskin was measured after surgery using standardized procedures. Nine hundred and sixty-five initially HIV-negative men were enrolled in a community cohort who subsequently enrolled in the male circumcision trials, provided 3920.8 person-years of observation prior to circumcision. We estimated HIV incidence per 100 person-years prior to circumcision, associated with foreskin surface area categorized into quartiles.

Browsing by Author "Gray, Ronald H."

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