Title

HIV positivity by age among VMMC clients in 14 countries and comparison to PHIA results

Presenter

D. Heather Watts

Authors

D.H. Watts¹, C. Cooney¹, J.S. Cavanaugh¹, N. Kothegal², H. Patel², V. Kiggundu³, A.G. Thomas⁴, N. Parks³, C. Toledo²

Institutions

¹U.S. Department of State, Office of the Global AIDS Coordinator, Washington, United States, ²Centers for Disease Control and Prevention, US DHHS, Division of Global HIV and TB, Atlanta, United States, ³U.S. Agency for International Development, Office of HIV/AIDS, Washington, United States, ⁴U.S. Department of Defense, DoD HIV/AIDS Prevention Program, Defense Health Agency, San Diego, United States

Background: Voluntary medical male circumcision (VMMC) is an important HIV prevention modality, conferring a long-term 60% reduction in HIV acquisition risk for men. VMMC programs include HIV education and offer testing. Starting in 2017, PEPFAR incorporated age-disaggregated reporting of HIV testing results in VMMC programs. These results could potentially provide insight on HIV prevalence in the general male population. We evaluated the results by age across countries to assess testing yield and to compare to published data from Population-based HIV Impact Assessments (PHIA) surveys completed between 2016-2017 where available.
Methods: Data regarding status among those testing at VMMC sites (positive, negative, unknown) and positivity rate by age bands were analyzed globally and within each country. For countries, where age disaggregated data from the PHIA surveys have been published, prevalences were compared by inspection to evaluate comparability.
Results: HIV status among all clients testing at VMMC sites in 2017 was negative in 3,002,941 (91.5%), positive in 24,101 (0.7%), and unknown in 256,159 (7.8%). Age disaggregated data were available for 68% of VMMC clients tested for HIV. Results by age band are shown in the table. The rate of positivity increases with age. PHIA confidence intervals did not include positivity rates in VMMC settings except in those under age 20 in Tanzania and Uganda and under age 15 in Zambia.

[HIV positivity by age in VMMC]

Conclusions: Despite low positivity in those below age 15, testing detects an important population of children living with HIV in some countries; age-diaggregated results allow countries to tailor testing strategies by age. All VMMC programs should have a mechanism to link those testing positive to treatment. HIV seroprevalence is lower among VMMC clients than population-based rates, suggesting potential prior testing or other self-selection factors among those seeking VMMC. These selection biases make VMMC testing not indicative of population rates of HIV.