Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019

Abstract

Introduction Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevalence of male circumcision (MC) in the subsequent years. Results of initial DMPPT2 modeling included implausible MC prevalence estimates, of up to 100%, for age bands whose sustained high uptake of VMMC pointed to unmet needs. Therefore, we conducted a cross-sectional survey among adolescents and men aged 10–29 years to determine the population level MC prevalence, guide target setting for achieving the goal of 80% MC prevalence and for validating DMPPT2 modelled estimates. Methods Beginning July to September 2019, a total of 3,569 adolescents and men aged 10–29 years from households in Siaya, Kisumu, Homa Bay and Migori Counties were interviewed and examined to establish the proportion already circumcised medically or non-medically. We measured agreement between self-reported and physically verified circumcision status and computed circumcision prevalence by age band and County. All statistical were test done at 5% level of significance. Results The observed MC prevalence for 15-29-year-old men was above 75% in all four counties; Homa Bay 75.6% (95% CI [69.0–81.2]), Kisumu 77.9% (95% CI [73.1–82.1]), Siaya 80.3% (95% CI [73.7–85.5]), and Migori 85.3% (95% CI [75.3–91.7]) but were 0.9–12.4% lower than DMPPT2-modelled estimates. For young adolescents 10–14 years, the observed prevalence ranged from 55.3% (95% CI [40.2–69.5]) in Migori to 74.9% (95% CI [68.8–80.2]) in Siaya and were 25.1–32.9% lower than DMMPT 2 estimates. Nearly all respondents (95.5%) consented to physical verification of their circumcision status with an agreement rate of 99.2% between self-reported and physically verified MC status (kappa agreement p-value<0.0001). Conclusion This survey revealed overestimation of MC prevalence from DMPPT2-model compared to the observed population MC prevalence and provided new reference data for setting realistic program targets and re-calibrating inputs into DMPPT2. Periodic population-based MC prevalence surveys, especially for established programs, can help reconcile inconsistencies between VMMC program uptake data and modeled MC prevalence estimates which are based on the number of procedures reported in the program annually.

Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010–2023—A systematic review and meta-analysis

“…In Kisumu, among men aged 15–49, three consecutive surveys [ 26 ] showed a male circumcision prevalence of 31.9 (95% CI 28.4–35.5) in 2009, 48.8% (95% CI 46.2–51.4) in 2011 and 59.7% (95% CI 57.0–62.3) in 2013. The remaining two studies reported a male circumcision prevalence of 50.6% (95% CI 49.3–51.9) in 2014 to 71.2% (95% CI 69.7–72.7) in 2019 in Siaya, Kisumu, Homa Bay and Migori Counties among men younger than 35 years [ 27 , 28 ].…”

Prevalence and risk factors of sexually transmitted infections in the setting of a generalized HIV epidemic—a population-based study, western Kenya

“…The odds of STI were 2-fold higher among circumcised vs. uncircumcised males, and over 50% of male participants were circumcised. The study area includes traditionally non-circumcising communities, 50 which since 2008, have been targeted by Kenya's National HIV Program for aggressive programmatic scale-up of VMMC to reduce HIV transmission risk among heterosexual men. [51][52][53] The protective effects of male circumcision may be partially offset by increased sexual risk behaviour as a result of lower perception of HIV infection risk after circumcision.…”

HIV Incidence, Recent HIV Infection, and Associated Factors, Kenya, 2007–2018

“…These reductions in recent HIV infections are likely due to multiple factors, including the scale-up of biomedical prevention interventions, including voluntary medical male circumcision (VMMC) in traditionally noncircumcising communities, 26 expansion of ART eligibility in 2012 and 2016, and rapid increases in HIV testing, diagnosis, and treatment leading to reduced population HIV viral load and subsequent transmission. Although disparities in educational attainment and household wealth were not consistently linked to greater individual risk of recent HIV infection as shown in Rakai, Uganda, 27 societal changes, such as increasing household wealth and increasing educational attainment, as well as behavioral changes may have contributed to overall reductions in HIV incidence.…”