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Rwabiyago OE, Katale A, Bingham T, Grund JM, Machangu O, Medley A, Nkomela ZM, Kayange A, King'ori GN, Juma JM, Ismail A, Kategile U, Akom E, Mlole NT, Schaad N, Maokola W, Nyagonde N, Magesa D, Kazitanga JC, Maruyama H, Temu F, Kimambo S, Sando D, Mbatia R, Chalamila ST, Ogwang BE, Njelekela MA, Kazaura K, Wong VJ, Gongo R, Njau PF, Mbunda A, Nondi J, Bateganya M, Greene J, Breda M, Mgomella G, Rwebembera A, Swaminathan M. Social network strategy (SNS) for HIV testing: a new approach for identifying individuals with undiagnosed HIV infection in Tanzania. AIDS Care 2024:1-10. [PMID: 38502602 DOI: 10.1080/09540121.2024.2307383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/10/2024] [Indexed: 03/21/2024]
Abstract
Social network strategy (SNS) testing uses network connections to refer individuals at high risk to HIV testing services (HTS). In Tanzania, SNS testing is offered in communities and health facilities. In communities, SNS testing targets key and vulnerable populations (KVP), while in health facilities it complements index testing by reaching unelicited index contacts. Routine data were used to assess performance and trends over time in PEPFAR-supported sites between October 2021 and March 2023. Key indicators included SNS social contacts tested, and new HIV-positives individuals identified. Descriptive and statistical analysis were conducted. Univariable and multivariable analysis were applied, and variables with P-values <0.2 at univariable analysis were considered for multivariable analysis. Overall, 121,739 SNS contacts were tested, and 7731 (6.4%) previously undiagnosed individuals living with HIV were identified. Tested contacts and identified HIV-positives were mostly aged ≥15 years (>99.7%) and females (80.6% of tests, 79.4% of HIV-positives). Most SNS contacts were tested (78,363; 64.7%) and diagnosed (6376; 82.5%) in communities. SNS tests and HIV-positives grew 11.5 and 6.1-fold respectively, from October-December 2021 to January-March 2023, with majority of clients reached in communities vs. facilities (78,763 vs. 42,976). These results indicate that SNS testing is a promising HIV case-finding approach in Tanzania.
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Affiliation(s)
- Oscar Ernest Rwabiyago
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Allen Katale
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Trista Bingham
- United States Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, Georgia, USA
| | - Jonathan M Grund
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Ona Machangu
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Amy Medley
- United States Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, Georgia, USA
| | - Zeye M Nkomela
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Alick Kayange
- United States Walter Reed Army Institute of Research/Department of Defense (WRAIR/DOD), Dar es Salaam, Tanzania
| | - Galal Naphtal King'ori
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - James McOllogi Juma
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Abbas Ismail
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Upendo Kategile
- United States Agency for International Development, Dar es Salaam, Tanzania
| | - Eniko Akom
- U.S. Military HIV Research Program (MHRP), Walter Reed Army Institute of Research, Silver Spring, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Neema Tabian Mlole
- President's Office, Regional Administration and Local Government, Dodoma, Tanzania
| | - Nicolas Schaad
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Werner Maokola
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Nyagonde Nyagonde
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Daniel Magesa
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Jaiving C Kazitanga
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | | | | | - Sajida Kimambo
- USAID Afya Yangu Northern Project, Dar es Salaam, Tanzania
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | | | | | | | - Kokuhumbya Kazaura
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Vincent J Wong
- United States Agency for International Development, Office of HIV/AIDS, Washington DC, USA
| | - Ramadhani Gongo
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Prosper Faustine Njau
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Andrea Mbunda
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Joseph Nondi
- United States Walter Reed Army Institute of Research/Department of Defense (WRAIR/DOD), Dar es Salaam, Tanzania
| | - Moses Bateganya
- United States Agency for International Development, Dar es Salaam, Tanzania
| | | | - Mark Breda
- United States Walter Reed Army Institute of Research/Department of Defense (WRAIR/DOD), Dar es Salaam, Tanzania
| | - George Mgomella
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
| | - Anath Rwebembera
- Tanzania Ministry of Health: The National AIDS, STIs and Hepatitis Control Program, Dodoma, Tanzania
| | - Mahesh Swaminathan
- United States Centers for Disease Control and Prevention, Dar es Salaam, Division of Global HIV and TB, Dar es Salaam, Tanzania
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Aheron S, Paredes-Vincent A, Patton ME, Gross J, Medley A, Mona G, Mtimkulu N, Nkuna K, Grund JM. Improving HIV Case Finding Through Index Testing: Findings from Health Facilities in 12 Districts of South Africa, October 2019-September 2021. AIDS Behav 2024:10.1007/s10461-024-04269-3. [PMID: 38358586 DOI: 10.1007/s10461-024-04269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/16/2024]
Abstract
To assess the importance of index testing in HIV case finding, we analyzed quarterly data from October 2019 to September 2021 from 371 facilities in 12 districts in South Africa. Index testing accounted for 2.6% of all HIV tests (index and non-index) (n = 163,633), but 17.8% of all HIV-positive results, with an HIV-positivity 4-times higher than non-index testing modalities (4.1%). Despite twice as many adult females ≥ 15 years accepting index testing (n = 206,715) compared to adult males ≥ 15 years (n = 102,180), females identified fewer contacts (n = 91,123) than males (n = 113,939). Slightly more than half (51.2%) of all contacts elicited were tested (n = 163,633/319,680), while 19.7% (n = 62,978) of elicited contacts were previously diagnosed as HIV-positive and not eligible for further testing. These findings indicate index testing can be effective in increasing HIV diagnoses in South Africa. Further operational research is needed to address gaps identified in the index testing cascade, including elicitation and testing of contacts.
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Affiliation(s)
- Sarah Aheron
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa.
| | - Ariana Paredes-Vincent
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Monica E Patton
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | - Jessica Gross
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Amy Medley
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Gugu Mona
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
| | | | - Khensani Nkuna
- Wits Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa
| | - Jonathan M Grund
- Division of Global HIV and TB, Centers for Disease Control & Prevention, Pretoria, South Africa
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3
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Peck ME, Ong K, Lucas T, Thomas AG, Wandira R, Ntwaaga B, Mkhontfo M, Zegeye T, Yohannes F, Mulatu D, Gultie T, Juma AW, Odoyo-June E, Maida A, Msungama W, Canda M, Mutandi G, Zemburuka BLT, Kankindi I, Vranken P, Maphothi N, Loykissoonlal D, Bunga S, Grund JM, Kazaura KJ, Kabuye G, Chituwo O, Muyunda B, Kamboyi R, Lingenda G, Mandisarisa J, Peterson A, Malaba R, Xaba S, Moyo T, Toledo C. Preventing HIV Among Adolescent Boys and Young Men Through PEPFAR-Supported Voluntary Medical Male Circumcision in 15 Sub-Saharan African Countries, 2018-2021. AIDS Educ Prev 2023; 35:67-81. [PMID: 37406146 PMCID: PMC11002756 DOI: 10.1521/aeap.2023.35.suppa.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Voluntary medical male circumcision (VMMC) is an HIV prevention intervention that has predominantly targeted adolescent and young men, aged 10-24 years. In 2020, the age eligibility for VMMC shifted from 10 to 15 years of age. This report describes the VMMC client age distribution from 2018 to 2021, at the site, national, and regional levels, among 15 countries in southern and eastern Africa. Overall, in 2018 and 2019, the highest proportion of VMMCs were performed among 10-14-year-olds (45.6% and 41.2%, respectively). In 2020 and 2021, the 15-19-year age group accounted for the highest proportion (37.2% and 50.4%, respectively) of VMMCs performed across all age groups. Similarly, in 2021 at the site level, 68.1% of VMMC sites conducted the majority of circumcisions among men aged 15-24 years. This analysis highlights that adolescent boys and young men are the primary recipients of VMMC receiving an important lifetime reduction in HIV risk.
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Affiliation(s)
- Megan E Peck
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Katherine Ong
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Todd Lucas
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Anne G Thomas
- HIV/AIDS Prevention Program, U.S. Department of Defense, San Diego, California
| | - Ronald Wandira
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | - Mandzisi Mkhontfo
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Tiruneh Zegeye
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Fikirte Yohannes
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Dejene Mulatu
- Disease Prevention and Control Directorate Senior, HIV Prevention and Control Expert, Addis Ababa, Ethiopia
| | | | | | - Elijah Odoyo-June
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Alice Maida
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Wezi Msungama
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Marcos Canda
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Gram Mutandi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Brigitte L T Zemburuka
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Ida Kankindi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Peter Vranken
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Nandi Maphothi
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | - Sudhir Bunga
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Jonathan M Grund
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Kokuhumbya J Kazaura
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Geoffrey Kabuye
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Omega Chituwo
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Brian Muyunda
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | | | - John Mandisarisa
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Amy Peterson
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | - Rickie Malaba
- The following authors are affiliated with the respective country offices of the Division of Global HIV and TB, CGH, CDC: Ronald Wandira (Gaborone, Botswana), Mandzisi Mkhontfo (Mbabane, Eswatini), Tiruneh Zegeye, and Fikirte Yohannes (Addis Ababa, Ethiopia), Elijah Odoyo-June (Nairobi, Kenya), Alice Maida, and Wezi Msungama (Lilongwe, Malawi), Marcos Canda (Maputo, Mozambique), Gram Mutandi, and Brigitte L. T. Zemburuka (Windhoek, Namibia), Ida Kankindi (Kigali, Rwanda), Peter Vranken, and Nandi Maphothi (Pretoria, South Africa), Sudhir Bunga (Juba, South Sudan), Jonathan M. Grund, and Kokuhumbya J. Kazaura (Dar es Salaam, Tanzania), Geoffrey Kabuye (Kampala, Uganda), Omega Chituwo, and Brian Muyunda (Lusaka, Zambia), and John Mandisarisa, Amy Peterson, and Rickie Malaba (Harare, Zimbabwe)
| | | | - Talent Moyo
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - Carlos Toledo
- Division of Global HIV and Tuberculosis (TB), Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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4
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Grund JM, Onchiri F, Mboya E, Ussery F, Musingila P, Ohaga S, Odoyo-June E, Bock N, Ayieko B, Agot K. Strategies to increase uptake of voluntary medical male circumcision among men aged 25-39 years in Nyanza Region, Kenya: Results from a cluster randomized controlled trial (the TASCO study). PLoS One 2023; 18:e0276593. [PMID: 36735665 PMCID: PMC9897540 DOI: 10.1371/journal.pone.0276593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/04/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Voluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region. MATERIALS AND METHODS We conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome. RESULTS At baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67. DISCUSSION Using these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02497989.
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Affiliation(s)
- Jonathan M. Grund
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Frankline Onchiri
- Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Edward Mboya
- Impact Research and Development Organization, Kisumu, Kenya
| | - Faith Ussery
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Paul Musingila
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Naomi Bock
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benard Ayieko
- Impact Research and Development Organization, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
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5
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Chetty-Makkan CM, Grund JM, Muchiri E, Price MA, Latka MH, Charalambous S. High risk sexual behaviours associated with traditional beliefs about gender roles among men interested in medical male circumcision in South Africa. AIDS Res Ther 2021; 18:33. [PMID: 34158082 PMCID: PMC8220767 DOI: 10.1186/s12981-021-00359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Beliefs about gender roles and high-risk sexual behaviours underlie the human immunodeficiency virus (HIV) epidemic in South Africa. Yet, there is limited information on the relationships between beliefs about gender roles and risky sexual behaviours. Few studies have explored the association between beliefs about gender roles, high risk sexual behaviour, and health-seeking behaviour among men. METHODS We investigated associations between gender beliefs (dichotomised as traditional or progressive) and high-risk sexual behaviour among South African men presenting for medical male circumcision (Apr 2014 to Nov 2015). RESULTS Of 2792 enrolled men, 47.4% reported traditional gender beliefs. Participant ages ranged between 18-46 years (median age 26 years; interquartile range, 21-31 years). Most participants had at least one sex partner over the last 12 months (68.2%). Younger men (18-24 years old vs. 25-46 years old) (odds ratio [OR], 1.5 [95% confidence interval (CI) 1.0-2.0]), those with multiple partners ([OR], 1.5 (CI) 1.3-1.8]) and participants unsure of their last partner's HIV status (OR, 1.4 [95% CI 1.1-1.7]) were more likely to have traditional beliefs on gender roles. CONCLUSION Young men with traditional beliefs on gender roles may be more likely to engage in high-risk sexual behaviour and could be good candidates for HIV prevention programmes. N = 206 (max 350) Trial registration Name of registry: Clinicaltrials.gov; Trial registration number: NCT02352961; Date of registration: 30 January 2015 "Retrospectively registered"; URL of trial registry record: https://www.clinicaltrials.gov/.
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Affiliation(s)
- Candice M. Chetty-Makkan
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
| | - Jonathan M. Grund
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Evans Muchiri
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
| | - Matt A. Price
- IAVI, New York, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Mary H. Latka
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Aurum House, The Ridge, 29 Queens Road, Parktown, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Grund JM, Bryant TS, Toledo C, Jackson I, Curran K, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Bock N, Taliano J, Davis SM. Correction to: Association of Male Circumcision with Women's Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review. AIDS Behav 2020; 24:344. [PMID: 31214865 DOI: 10.1007/s10461-019-02553-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The article Association of Male Circumcision with Women's Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review, written by Jonathan M. Grund, Tyler S. Bryant, Carlos Toledo, Inimfon Jackson, Kelly Curran, Sheng Zhou, Jorge Martin del Campo, Ling Yang, Apollo Kivumbi, Peizi Li, Naomi Bock, Joanna Taliano, Stephanie M. Davis was originally published electronically on the publisher's internet portal (currently SpringerLink) on 24 October 2018 without open access.
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Affiliation(s)
- Jonathan M Grund
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Toledo
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naomi Bock
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Joanna Taliano
- Division of Public Health Information Dissemination (DPHID), Library Science Branch, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Atlanta, GA, USA
| | - Stephanie M Davis
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA.
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7
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Torres-Rueda S, Wambura M, Weiss HA, Plotkin M, Kripke K, Chilongani J, Mahler H, Kuringe E, Makokha M, Hellar A, Schutte C, Kazaura KJ, Simbeye D, Mshana G, Larke N, Lija G, Changalucha J, Vassall A, Hayes R, Grund JM, Terris-Prestholt F. Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less. J Acquir Immune Defic Syndr 2019; 78:291-299. [PMID: 29557854 PMCID: PMC6012046 DOI: 10.1097/qai.0000000000001682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Although voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition, demand for services is lower among men in most at-risk age groups (ages 20–34 years). A randomized controlled trial was conducted to assess the effectiveness of locally-tailored demand creation activities (including mass media, community mobilization, and targeted service delivery) in increasing uptake of campaign-delivered VMMC among men aged 20–34 years. We conducted an economic evaluation to understand the intervention's cost and cost-effectiveness. Setting: Tanzania (Njombe and Tabora regions). Methods: Cost data were collected on surgery, demand creation activities, and monitoring and supervision related to VMMC implementation across clusters in both trial arms, as well as start-up activities for the intervention arms. The Decision Makers' Program Planning Tool was used to estimate the number of HIV infections averted and related cost savings, given the total VMMCs per cluster. Disability-adjusted life years were calculated and used to estimate incremental cost-effectiveness ratios. Results: Client load was higher in the intervention arms than in the control arms: 4394 vs. 2901 in Tabora and 1797 vs. 1025 in Njombe, respectively. Despite additional costs of tailored demand creation, demand increased more than proportionally: mean costs per VMMC in the intervention arms were $62 in Tabora and $130 in Njombe, and in the control arms $70 and $191, respectively. More infections were averted in the intervention arm than in the control arm in Tabora (123 vs. 67, respectively) and in Njombe (164 vs. 102, respectively). The intervention dominated the control because it was both less costly and more effective. Cost savings were observed in both regions stemming from the antiretroviral treatment costs averted as a result of the VMMCs performed. Conclusions: Spending more to address local preferences as a way to increase uptake of VMMC can be cost-saving.
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Affiliation(s)
- Sergio Torres-Rueda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mwita Wambura
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marya Plotkin
- Jhpiego Tanzania, Dar es Salaam, Tanzania.,Currently, Jhpiego, Baltimore, MD
| | | | - Joseph Chilongani
- National Institute for Medical Research (NIMR), Mwanza, Tanzania.,Currently, District Commissioner's Office, Meatu, Simiyu, Tanzania
| | - Hally Mahler
- Jhpiego Tanzania, Dar es Salaam, Tanzania.,Current, FHI360, Washington, DC
| | - Evodius Kuringe
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | | | - Carl Schutte
- Strategic Development Consultants, Durban, South Africa
| | - Kokuhumbya J Kazaura
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Dar es Salaam, Tanzania
| | - Daimon Simbeye
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Dar es Salaam, Tanzania
| | - Gerry Mshana
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Natasha Larke
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gissenge Lija
- Ministry of Health and Social Welfare, National AIDS Control Program, Dar es Salaam, Tanzania
| | - John Changalucha
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jonathan M Grund
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Atlanta, GA.,Currently, Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Pretoria, South Africa
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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8
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Ong JJ, Neke N, Wambura M, Kuringe E, Grund JM, Plotkin M, d'Elbée M, Torres-Rueda S, Mahler HR, Weiss HA, Terris-Prestholt F. Use of Lotteries for the Promotion of Voluntary Medical Male Circumcision Service: A Discrete-Choice Experiment among Adult Men in Tanzania. Med Decis Making 2019; 39:474-485. [PMID: 31179868 DOI: 10.1177/0272989x19852095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Voluntary medical male circumcision (VMMC) is effective in reducing the risk of human immunodeficiency virus (HIV). However, countries like Tanzania have high HIV prevalence but low uptake of VMMC. We conducted a discrete-choice experiment to evaluate the preferences for VMMC service attributes in a random sample of 325 men aged 18 years or older from the general population in 2 Tanzanian districts, Njombe and Tabora. We examined the preference for financial incentives in the form of a lottery ticket or receiving a guaranteed transport voucher for attendance at a VMMC service. We created a random-parameters logit model to account for individual preference heterogeneity and a latent class analysis model for identifying groups of men with similar preferences to test the hypothesis that men who reported sexually risky behaviors (i.e., multiple partners and any condomless sex in the past 12 months) may have a preference for participation in a lottery-based incentive. Most men preferred a transport voucher (84%) over a lottery ticket. We also found that offering a lottery-based financial incentive may not differentially attract those with greater sexual risk. Our study highlights the importance of gathering local data to understand preference heterogeneity, particularly regarding assumptions around risk behaviors.
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Affiliation(s)
- Jason J Ong
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Australia
| | - Nyasule Neke
- National Institute of Medical Research, Mwanza, Tanzania
| | - Mwita Wambura
- National Institute of Medical Research, Mwanza, Tanzania
| | | | - Jonathan M Grund
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Marc d'Elbée
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sergio Torres-Rueda
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
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9
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Grund JM, Bryant TS, Toledo C, Jackson I, Curran K, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Bock N, Taliano J, Davis SM. Association of Male Circumcision with Women's Knowledge of its Biomedical Effects and With Their Sexual Satisfaction and Function: A Systematic Review. AIDS Behav 2019; 23:1104-1114. [PMID: 30357642 PMCID: PMC6557870 DOI: 10.1007/s10461-018-2313-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Male circumcision (MC) is a key HIV prevention intervention for men in countries with high HIV prevalence. Women's understanding of MC is important but poorly understood. We conducted a systematic review including women's knowledge of MC's biomedical impacts and its association with female sexual satisfaction and function through October 2017. Thirty-eight articles were identified: thirty-two with knowledge outcomes, seven with sexual satisfaction, and four with sexual function (N = 38). Respondent proportions aware MC protects men from HIV were 9.84-91.8% (median 60.0%). Proportions aware MC protects men from STIs were 14.3-100% (72.6%). Proportions aware MC partially protects men from HIV were 37.5-82% (50.7%). Proportions aware MC is not proven to protect women from infection by an HIV-positive partner were 90.0-96.8% (93.0%). No increases over time were noted. Women's MC knowledge is variable. Education could help women support MC and make better-informed sexual decisions.
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Affiliation(s)
- Jonathan M Grund
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Toledo
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naomi Bock
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA
| | - Joanna Taliano
- Division of Public Health Information Dissemination (DPHID), Library Science Branch, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Atlanta, GA, USA
| | - Stephanie M Davis
- Division of Global HIV and TB, HIV Prevention Branch, US Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E04, Atlanta, GA, 30329, USA.
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10
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Terris-Prestholt F, Neke N, Grund JM, Plotkin M, Kuringe E, Osaki H, Ong JJ, Tucker JD, Mshana G, Mahler H, Weiss HA, Wambura M. Using discrete choice experiments to inform the design of complex interventions. Trials 2019; 20:157. [PMID: 30832718 PMCID: PMC6399844 DOI: 10.1186/s13063-019-3186-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Complex health interventions must incorporate user preferences to maximize their potential effectiveness. Discrete choice experiments (DCEs) quantify the strength of user preferences and identify preference heterogeneity across users. We present the process of using a DCE to supplement conventional qualitative formative research in the design of a demand creation intervention for voluntary medical male circumcision (VMMC) to prevent HIV in Tanzania. METHODS The VMMC intervention was designed within a 3-month formative phase. In-depth interviews (n = 30) and participatory group discussions (n = 20) sought to identify broad setting-specific barriers to and facilitators of VMMC among adult men. Qualitative results informed the DCE development, identifying the role of female partners, service providers' attitudes and social stigma. A DCE among 325 men in Njombe and Tabora, Tanzania, subsequently measured preferences for modifiable VMMC service characteristics. The final VMMC demand creation intervention design drew jointly on the qualitative and DCE findings. RESULTS While the qualitative research informed the community mobilization intervention, the DCE guided the specific VMMC service configuration. The significant positive utilities (u) for availability of partner counselling (u = 0.43, p < 0.01) and age-separated waiting areas (u = 0.21, p < 0.05) led to the provision of community information booths for partners and provision of age-separated waiting areas. The strong disutility of female healthcare providers (u = - 0.24, p < 0.01) led to re-training all providers on client-friendliness. CONCLUSION This is, to our knowledge, the first study documenting how user preferences from DCEs can directly inform the design of a complex intervention. The use of DCEs as formative research may help increase user uptake and adherence to complex interventions.
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Affiliation(s)
- Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH UK
| | - Nyasule Neke
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Jonathan M. Grund
- Centers for Disease Control and Prevention (CDC), Center for Global Health, Division of Global HIV & TB, Atlanta, GA 30333 USA
| | - Marya Plotkin
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231 USA
| | - Evodius Kuringe
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Haika Osaki
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Jason J. Ong
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH UK
| | - Joseph D. Tucker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
- University of North Carolina Chapel Hill Project—China, No. 2, Lujing Road, Guangzhou, 510095 China
| | - Gerry Mshana
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - Hally Mahler
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC 20009 USA
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
| | - Mwita Wambura
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
| | - The VMMC study team
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC1H 9SH UK
- National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
- Centers for Disease Control and Prevention (CDC), Center for Global Health, Division of Global HIV & TB, Atlanta, GA 30333 USA
- Jhpiego, 1615 Thames Street, Baltimore, MD 21231 USA
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
- University of North Carolina Chapel Hill Project—China, No. 2, Lujing Road, Guangzhou, 510095 China
- FHI 360, 1825 Connecticut Avenue NW, Washington, DC 20009 USA
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT UK
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Chetty-Makkan CM, Grund JM, Munyai R, Gadla V, Chihota V, Maraisane M, Charalambous S. "To speak or not to speak": A qualitative analysis on the attitude and willingness of women to start conversations about voluntary medical male circumcision with their partners in a peri-urban area, South Africa. PLoS One 2019; 14:e0210480. [PMID: 30682057 PMCID: PMC6347244 DOI: 10.1371/journal.pone.0210480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/25/2018] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Voluntary medical male circumcision (VMMC) reduces the risk of HIV infection in heterosexual men and has long-term indirect protection for women, yet VMMC uptake in South Africa remains low (49.8%) in men (25-49 years). We explored the attitude and willingness of women to start conversations on VMMC with their sexual partners in a South African peri-urban setting to increase VMMC uptake. METHODS Thirty women with median age of 30 years (inter-quartile range 26-33 years) were interviewed in a language of their choice. Key questions included: types of approach to use, gender roles, benefits and barriers to introducing the topic of VMMC, and perceptions of VMMC. Interviews were digitally-recorded, transcribed, and translated. Through a standard iterative process, a codebook was developed (QSR NVIVO 10 software) and inductive thematic analysis applied. RESULTS Most women were willing talk to their sexual partners about circumcision, but indicated that the decision to circumcise remained that of their sexual partner. Women felt that they should encourage their partners, show more interest in circumcision, be patient, speak in a caring and respectful tone, choose a correct time when their partner was relaxed and talk in a private space about VMMC. Using magazine/newspaper articles, pamphlets or advertisements were identified as tools that could aid their discussion. Substantial barriers to initiating conversations on VMMC included accusations by partner on infidelity, fear of gender-based violence, cultural restrictions and hesitation to speak to a mature partner about circumcision. CONCLUSIONS Women need to ensure that before talking to their partner about circumcision, the environment and approach that they use are conducive. Female social network forums could be used to educate women on conversation techniques, skills to use when talking to their partners and how to address communication challenges about circumcision. Involvement of women in VMMC awareness campaigns could encourage circumcision uptake among men.
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Affiliation(s)
| | - Jonathan M. Grund
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | | | | | | | - Salome Charalambous
- The Aurum Institute, Parktown, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Davis SM, Hines JZ, Habel M, Grund JM, Ridzon R, Baack B, Davitte J, Thomas A, Kiggundu V, Bock N, Pordell P, Cooney C, Zaidi I, Toledo C. Progress in voluntary medical male circumcision for HIV prevention supported by the US President's Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data. BMJ Open 2018; 8:e021835. [PMID: 30173159 PMCID: PMC6120649 DOI: 10.1136/bmjopen-2018-021835] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This article provides an overview and interpretation of the performance of the US President's Emergency Plan for AIDS Relief's (PEPFAR's) male circumcision programme which has supported the majority of voluntary medical male circumcisions (VMMCs) performed for HIV prevention, from its 2007 inception to 2017, and client characteristics in 2017. DESIGN Longitudinal collection of routine programme data and disaggregations. SETTING 14 countries in sub-Saharan Africa with low baseline male circumcision coverage, high HIV prevalence and PEPFAR-supported VMMC programmes. PARTICIPANTS Clients of PEPFAR-supported VMMC programmes directed at males aged 10 years and above. MAIN OUTCOME MEASURES Numbers of circumcisions performed and disaggregations by age band, result of HIV test offer, procedure technique and follow-up visit attendance. RESULTS PEPFAR supported a total of 15 269 720 circumcisions in 14 countries in Southern and Eastern Africa. In 2017, 45% of clients were under 15 years of age, 8% had unknown HIV status, 1% of those tested were HIV+ and 84% returned for a follow-up visit within 14 days of circumcision. CONCLUSIONS Over 15 million VMMCs have been supported by PEPFAR since 2007. VMMC continues to attract primarily young clients. The non-trivial proportion of clients not testing for HIV is expected, and may be reassuring that testing is not being presented as mandatory for access to circumcision, or in some cases reflect test kit stockouts or recent testing elsewhere. While VMMC is extremely safe, achieving the highest possible follow-up rates for early diagnosis and intervention on complications is crucial, and programmes continue to work to raise follow-up rates. The VMMC programme has achieved rapid scale-up but continues to face challenges, and new approaches may be needed to achieve the new Joint United Nations Programme on HIV/AIDS goal of 27 million additional circumcisions through 2020.
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Affiliation(s)
- Stephanie M Davis
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas Z Hines
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Habel
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan M Grund
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Renee Ridzon
- President's Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Brittney Baack
- Division of Global HIV and TB, Monitoring, Evaluation, and Data Analytics Branch, Clinical Monitoring and Evaluation Team, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Davitte
- US Department of Defense HIV/AIDS Prevention Program (DHAPP), Naval Health Research Center, San Diego, California, USA
| | - Anne Thomas
- US Department of Defense HIV/AIDS Prevention Program (DHAPP), Naval Health Research Center, San Diego, California, USA
| | - Valerian Kiggundu
- United States Agency for International Development, Global Health Bureau, Office of HIV/AIDS, Prevention, Care and Treatment Division, Washington, District of Columbia, USA
| | - Naomi Bock
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paran Pordell
- Division of Global HIV and TB, Monitoring, Evaluation, and Data Analytics Branch, Clinical Monitoring and Evaluation Team, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caroline Cooney
- President's Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Irum Zaidi
- President's Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
| | - Carlos Toledo
- Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Carrasco MA, Grund JM, Davis SM, Ridzon R, Mattingly M, Wilkinson J, Kasdan B, Kiggundu V, Njeuhmeli E. Systematic review of the effect of economic compensation and incentives on uptake of voluntary medical male circumcision among men in sub-Saharan Africa. AIDS Care 2018; 30:1071-1082. [PMID: 29566546 PMCID: PMC6800131 DOI: 10.1080/09540121.2018.1453921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Voluntary medical male circumcision (VMMC) prevalence in priority countries in sub-Saharan Africa, particularly among men aged ≥20 years, has not yet reached the goal of 80% coverage recommended by the World Health Organization. Determining novel strategies to increase VMMC uptake among men ≥20 years is critical to reach HIV epidemic control. We conducted a systematic review to analyze the effectiveness of economic compensation and incentives to increase VMMC uptake among older men in order to inform VMMC demand creation programs. The review included five qualitative, quantitative, and mixed methods studies published in peer reviewed journals. Data was extracted into a study summary table, and tables synthesizing study characteristics and results. Results indicate that cash reimbursements for transportation and food vouchers of small nominal amounts to partially compensate for wage loss were effective, while enrollment into lotteries offering prizes were not. Economic compensation provided a final push toward VMMC uptake for men who had already been considering undergoing circumcision. This was in settings with high circumcision prevalence brought by various VMMC demand creation strategies. Lottery prizes offered in the studies did not appear to help overcome barriers to access VMMC and qualitative evidence suggests this may partially explain why they were not effective. Economic compensation may help to increase VMMC uptake in priority countries with high circumcision prevalence when it addresses barriers to uptake. Ethical considerations, sustainability, and possible externalities should be carefully analyzed in countries considering economic compensation as an additional strategy to increase VMMC uptake.
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Affiliation(s)
- Maria A. Carrasco
- U.S. Agency for International Development (USAID), Washington DC, USA
| | | | | | | | - Meghan Mattingly
- U.S. Agency for International Development (USAID), Washington DC, USA
| | - Jessica Wilkinson
- U.S. Agency for International Development (USAID), Washington DC, USA
| | - Benjamin Kasdan
- U.S. Agency for International Development (USAID), Washington DC, USA
| | - Valerian Kiggundu
- U.S. Agency for International Development (USAID), Washington DC, USA
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Grund JM, Chetty-Makkan CM, Ginindza S, Munyai R, Kisbey-Green H, Maraisane M, Charalambous S. Effectiveness of an "Exclusive Intervention Strategy" to increase medical male circumcision uptake among men aged 25-49 years in South Africa. BMC Public Health 2018; 18:868. [PMID: 30005663 PMCID: PMC6044089 DOI: 10.1186/s12889-018-5729-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa introduced medical male circumcision (MMC) to reduce HIV incidence. Mathematical modeling suggested that targeting MMC services to men aged 20-34 years could provide the most immediate impact on HIV incidence. However the majority of MMCs performed have been among males aged ≤25 years. We evaluated an intervention package to increase MMC uptake among men aged 25-49 years. METHODS We conducted a pre-post study to compare the proportion of men (aged 25-49 years) presenting for MMC during the formative (Phase 1) and intervention (Phase 2) phases in Ekurhuleni, Johannesburg, South Africa. The intervention included infrastructure changes that separated adults from adolescents at the MMC site, an exclusive men's health club, adult-specific demand generation materials, and discussions with community members. RESULTS Overall 2817 enrolled in the study with 1601 from Phase 1 and 1216 in Phase 2. A higher proportion of participants aged 25-49 years accessed MMC in Phase 2 compared to Phase 1 (59.4% vs. 54.9%; Prevalence Ratio = 1.08; 95% Confidence Interval: 1.01-1.15; p = 0.019). Participants with multiple partners in the past 12 months in Phase 2 were more likely to access MMC services compared to participants in Phase 1 (unadjusted Odds Ratio, 1.37; 95% CI:1.17-1.61; p < 0.001). After adjusting for age, multiple partners remained a risk factor in Phase 2 (adjusted OR, 1.39; 95% CI: 1.18-1.63; p < 0.001). CONCLUSIONS The "Exclusive Intervention Strategy" was associated with a slight increase in the proportion of participants aged 25-49 years accessing MMC services, and an increase in those with HIV risk behaviors, during the intervention phase. These findings may provide important insights to overcoming barriers for accessing MMC services among men aged 25-49 years. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov , number NCT02352961 .
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Affiliation(s)
- Jonathan M Grund
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-E04, Atlanta, GA, 30333, USA.
| | | | - Sibuse Ginindza
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
| | - Reuben Munyai
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
| | | | - Mpho Maraisane
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
- The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Hinkle LE, Toledo C, Grund JM, Byams VR, Bock N, Ridzon R, Cooney C, Njeuhmeli E, Thomas AG, Odhiambo J, Odoyo-June E, Talam N, Matchere F, Msungama W, Nyirenda R, Odek J, Come J, Canda M, Wei S, Bere A, Bonnecwe C, Choge IA, Martin E, Loykissoonlal D, Lija GJ, Mlanga E, Simbeye D, Alamo S, Kabuye G, Lubwama J, Wamai N, Chituwo O, Sinyangwe G, Zulu JE, Ajayi CA, Balachandra S, Mandisarisa J, Xaba S, Davis SM. Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2015-2016. MMWR Morb Mortal Wkly Rep 2018; 67:337-339. [PMID: 29565839 PMCID: PMC5868201 DOI: 10.15585/mmwr.mm6711a6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Hines JZ, Ntsuape OC, Malaba K, Zegeye T, Serrem K, Odoyo-June E, Nyirenda RK, Msungama W, Nkanaunena K, Come J, Canda M, Nhaguiombe H, Shihepo EK, Zemburuka BL, Mutandi G, Yoboka E, Mbayiha AH, Maringa H, Bere A, Lawrence JJ, Lija GJ, Simbeye D, Kazaura K, Mwiru RS, Talisuna SA, Lubwama J, Kabuye G, Zulu JE, Chituwo O, Mumba M, Xaba S, Mandisarisa J, Baack BN, Hinkle L, Grund JM, Davis, SM, Toledo C. Scale-Up of Voluntary Medical Male Circumcision Services for HIV Prevention - 12 Countries in Southern and Eastern Africa, 2013-2016. MMWR Morb Mortal Wkly Rep 2017; 66:1285-1290. [PMID: 29190263 PMCID: PMC5708689 DOI: 10.15585/mmwr.mm6647a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Grund JM, Bryant TS, Jackson I, Curran K, Bock N, Toledo C, Taliano J, Zhou S, Del Campo JM, Yang L, Kivumbi A, Li P, Pals S, Davis SM. Association between male circumcision and women's biomedical health outcomes: a systematic review. Lancet Glob Health 2017; 5:e1113-e1122. [PMID: 29025633 PMCID: PMC5728090 DOI: 10.1016/s2214-109x(17)30369-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/21/2017] [Accepted: 08/25/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Male circumcision reduces men's risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women's health outcomes to benefit women's health programmes. METHODS In this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women's health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency. FINDINGS 60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate. INTERPRETATION Scale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly consistent. Synergies between male circumcision and women's health programmes should be explored. FUNDING US Centers for Disease Control and Prevention and Jhpiego.
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Affiliation(s)
- Jonathan M Grund
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Tyler S Bryant
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Inimfon Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Naomi Bock
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Carlos Toledo
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Joanna Taliano
- LAC Group, Contractor to US Centers for Disease Control and Prevention, Library Science Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, USA
| | - Sheng Zhou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ling Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Apollo Kivumbi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peizi Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sherri Pals
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA
| | - Stephanie M Davis
- US Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, GA, USA.
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Odoyo-June E, Agot K, Grund JM, Onchiri F, Musingila P, Mboya E, Emusu D, Onyango J, Ohaga S, Soo L, Otieno-Nyunya B. Predictors of voluntary medical male circumcision prevalence among men aged 25-39 years in Nyanza region, Kenya: Results from the baseline survey of the TASCO study. PLoS One 2017; 12:e0185872. [PMID: 28982175 PMCID: PMC5628861 DOI: 10.1371/journal.pone.0185872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/21/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Uptake of voluntary medical male circumcision (VMMC) as an intervention for prevention of HIV acquisition has been low among men aged ≥25 years in Nyanza region, western Kenya. We conducted a baseline survey of the prevalence and predictors of VMMC among men ages 25–39 years as part of the preparations for a cluster randomized controlled trial (cRCT) called the Target, Speed and Coverage (TASCO) Study. The TASCO Study aimed to assess the impact of two demand creation interventions—interpersonal communication (IPC) and dedicated service outlets (DSO), delivered separately and together (IPC + DSO)—on VMMC uptake. Methods As part of the preparatory work for implementation of the cRCT to evaluate tailored interventions to improve uptake of VMMC, we conducted a survey of men aged 25–39 years from a traditionally non-circumcising Kenyan ethnic community within non-contiguous locations selected as study sites. We determined their circumcision status, estimated the baseline circumcision prevalence and assessed predictors of being circumcised using univariate and multivariate logistic regression. Results A total of 5,639 men were enrolled of which 2,851 (50.6%) reported being circumcised. The odds of being circumcised were greater for men with secondary education (adjusted Odds Ratio (aOR) = 1.65; 95% CI: 1.45–1.86, p<0.001), post-secondary education (aOR = 1.72; 95% CI: 1.44–2.06, p <0.001), and those employed (aOR = 1.32; 95% CI: 1.18–1.47, p <0.001). However, the odds were lower for men with a history of being married (currently married, divorced, separated, or widowed). Conclusion Among adult men in the rural Nyanza region of Kenya, men with post-primary education and employed were more likely to be circumcised. VMMC programs should focus on specific sub-groups of men, including those aged 25–39 years who are married, divorced/separated/ widowed, and of low socio-economic status (low education and unemployed).
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Affiliation(s)
- Elijah Odoyo-June
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- * E-mail:
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Jonathan M. Grund
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Frankline Onchiri
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Paul Musingila
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Edward Mboya
- Impact Research and Development Organization, Kisumu, Kenya
| | - Donath Emusu
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Jacob Onyango
- Impact Research and Development Organization, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Leonard Soo
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Boaz Otieno-Nyunya
- Division of Global HIV & TB (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Grund JM, Toledo C, Davis SM, Ridzon R, Moturi E, Scobie H, Naouri B, Reed JB, Njeuhmeli E, Thomas AG, Benson FN, Sirengo MW, Muyenzi LN, Lija GJI, Rogers JH, Mwanasalli S, Odoyo-June E, Wamai N, Kabuye G, Zulu JE, Aceng JR, Bock N. Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention--Eastern and Southern Africa, 2012-2015. MMWR Morb Mortal Wkly Rep 2016; 65:36-7. [PMID: 26797167 DOI: 10.15585/mmwr.mm6502a5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.
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Abstract
Male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomized controlled trials. Less is known, however, about sexual behavior change in men who have been circumcised and whether male circumcision's protective effect leads to riskier sexual behaviors. This study used qualitative in-depth interviews to understand men's sexual behavior after circumcision and to determine whether and how men participated in riskier sexual behaviors following male circumcision. Men in urban Swaziland, circumcised in the previous 12 months, were recruited and asked about their perceptions of sexual risk and sexual behavior post-circumcision. Results showed that following circumcision, men experience changes in both their sexual attitudes and behavior, which can be considered both protective and risky for HIV transmission. Most of them described protective changes (e.g., more responsible attitudes towards safe sex, reducing sexual temptation and partners, easier condom use). A minority, however, experienced increased sexual risk-taking, typically during a brief period of sexual experimentation shortly after circumcision. HIV counseling and counseling throughout the circumcision process is shown to be critical in influencing protective behaviors. Findings in this study confirm the existence of risk compensation following circumcision; however, this study adds important contextual insight about precisely when and why such risk-taking occurs. Nevertheless this study suggests that male circumcision scale-up as an HIV prevention strategy is likely to foster protective behavior change among men. The integration of HIV counseling with circumcision provision remains critical for effectively mitigating HIV risk behavior as male circumcision gains momentum as a viable HIV prevention tool.
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Affiliation(s)
- Jonathan M Grund
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Affiliation(s)
- Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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