Celebrating 20+ Years of Public Health Research in Uganda

Read more about the history of our program.

Read the 2010 Rakai Report.

Trials of male circumcision for HIV and STI prevention in men and women

Between 2004 and 2009, the RHSP conducted two randomized controlled trials to assess the efficacy of male circumcision (MC) for HIV/sexually transmitted infection (STI) prevention in men and in women.

Male Circumcision (MC) for HIV Prevention, Rakai, Uganda (supported by NIH)

• Enrolled 4996 HIV-negative uncircumcised men aged 15-49 years who were randomized to receive either immediate circumcision (intervention arm) or MC delayed for 24 months (control arm).
• The objective was to determine safety and the effects of MC on the acquisition of HIV and sexually transmitted infections (STI) in men

Randomized Trial of Male Circumcision (MC), STD, HIV and Behavioral Effects in Men, Women and the Community (supported by the Gates Foundation)

• Enrolled 922 HIV-infected men who were randomized to immediate or delayed MC as well as the spouses of both HIV-infected and the HIV-negative male trial participants.
• All men were followed up at 6, 12 and 24 months; enrolled women partners were followed up at 12 and 24 months to determine HIV and STD acquisition, and assess sexual risk behaviors.
• The trial had two main goals:
  • to assess the safety of MC in HIV-infected men and the effects of circumcision on male STI acquisition
  • to assess whether MC would reduce the risk of HIV and STI transmission to female partners.

This trial also allowed us to follow the general population of the 50 RCCS villages to assess MC acceptability, and the effects of MC provision on community-level HIV/STI incidence and HIV risk behaviors.

To see results of trials, please read   2010 Rakai Report (bookmark 1 - Major Research Activities).

Research on the mechanisms by which male circumcision reduces the risk of HIV and viral STIs

With support from the Gates Foundation and NIAID, we have embarked on basic science studies of foreskin tissues.

The Challenges

Heterosexual HIV transmission occurs via the genital mucosa, but it has been difficult to study mucosal tissues. Foreskin tissues left over after circumcision provide access to mucosal tissues to study susceptibility or resistance to HIV infection, and to potentially provide insights that could lead to the development of mucosal vaccines or microbicides for HIV prevention.

Please read    2010 Rakai Report for more information (bookmark 2 - Research Mechanisms).

Operations research on male circumcision

With PEPFAR and WHO funding we have:

• Provided circumcision to >7,000 men after the trial
• Trained >300 circumcision providers (physicians, clinical officers, nurses and counselors) from many regions of Uganda
• Performed over >14,000 procedures, inclusive of trial participants (cumulatively)

Surgery is performed under local anesthesia in outpatient theaters and services have been extended to two satellite clinics.

Please read   2010 Rakai Report (bookmark 3 - Operations and Service Delivery).

HIV care, antiretroviral therapy and prevention of mother-to-child HIV transmission

Since 2004, the Rakai Program has provided HIV care to infected persons via our central clinic in the Rakai Health Sciences Center in Kalisizo and through 17 mobile Suubi (“Hope”) clinics which visit communities at biweekly intervals.

We have conducted research on adult HIV care, prevention of mother-to-child HIV transmission and on cognitive development of HIV-infected and uninfected children.

Up to now, all HIV-infected persons in Rakai District have been eligible for this free service

The central clinic includes:

• Exam rooms and pharmacy
• X-ray and abdominal ultrasound
• A well-equipped clinical diagnostic laboratory

Please read   2010 Rakai Report (bookmark 4 - HIV Care and ART).

Virology and Clinical Epidemiology

RHSP has conducted several studies on HIV subtype and disease progression/transmission, HIV superinfection and viral diversity in blood and tissue compartments. In addition, we have assessed the role of microbial translocation and hormonal contraception in disease progression, and the effects of HIV on hepatic and renal disease.

Please read   2010 Rakai Report (bookmark 5 - Virology Research).

To read more information about the following topics, please read the 2010 Rakai Report

• STIs and BV - bookmark 6 (Research on STIs)
• Research on couple HIV disclosure, stigma and prevention of interpersonal violence - bookmark 7 (Social and Behavioral Research and Evaluation)
• Rakai resources and facilities - bookmark 8 (Facilities)

List of Recent Publications

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