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

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254140
Author(s):  
Elijah Odoyo-June ◽  
Stephanie Davis ◽  
Nandi Owuor ◽  
Catey Laube ◽  
Jonesmus Wambua ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Program Planning ◽  
P Value ◽  
Voluntary Medical Male Circumcision ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Male Circumcision ◽  
Prevalence Estimates ◽  
Kappa Agreement ◽  
The Impact

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.

scholarly journals Voluntary Medical Male Circumcision: A Cross-Sectional Study Comparing Circumcision Self-Report and Physical Examination Findings in Lesotho

PLoS ONE ◽  
2011 ◽  
Vol 6 (11) ◽  
pp. e27561 ◽  
Author(s):  
Anne Goldzier Thomas ◽  
Bonnie Robin Tran ◽  
Marcus Cranston ◽  
Malerato Cecilia Brown ◽  
Rajiv Kumar ◽  
...  
Keyword(s):  
Physical Examination ◽  
Male Circumcision ◽  
Cross Sectional Study ◽  
Self Report ◽  
Voluntary Medical Male Circumcision ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Male Circumcision

PREDICTORS OF MALE CIRCUMCISION AMONG MEN AGED 15–35 YEARS IN HARARE, ZIMBABWE

2017 ◽  
Vol 50 (2) ◽  
pp. 193-211
Author(s):  
Kudzaishe Mangombe ◽  
Ishumael Kalule-Sabiti
Keyword(s):  
Hiv Prevention ◽  
Male Circumcision ◽  
Employment Status ◽  
Scale Up ◽  
World Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Male Circumcision ◽  
Sub Saharan ◽  
Health Organization

SummaryMedical male circumcision has been recommended by the World Health Organization as part of a comprehensive approach to HIV prevention. Zimbabwe is one of the fourteen sub-Saharan countries that embarked on the Medical Male Circumcision (MMC) programme. However, the country has not yet met male circumcision targets. This paper examines the predictors of male circumcision in Zimbabwe. A cross-sectional survey was conducted on 784 men aged 15–35 years in Harare, Zimbabwe. Negative log-log logistic regression analysis was used to determine the predictors of male circumcision. The main predictors of circumcision were age, employment status, ever tested for HIV, approval of HIV testing prior to circumcision, knowledge about male circumcision and attitudes towards male circumcision. By and large, participants had good knowledge about male circumcision and viewed HIV prevention with a reasonably positive attitude. The identification of these predictors can be used to scale up the demand for male circumcision in Zimbabwe.

scholarly journals Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Irene O. Chiringa ◽  
Dorah U. Ramathuba ◽  
Ntsieni S. Mashau
Keyword(s):  
Hiv Prevention ◽  
Male Circumcision ◽  
Target Population ◽  
Rural District ◽  
World Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical Male Circumcision ◽  
Health Organization ◽  
Randomised Controlled

Background: Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model.Purpose: The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC.Methods: The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data.Results: Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%).Conclusion: Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.Keywords: Factors, Low uptake, Medical Male Circumcision (MMC)

scholarly journals Prevalence and correlates of voluntary medical male circumcision adverse events among adult males in the Copperbelt Province of Zambia: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256955
Author(s):  
Imukusi Mutanekelwa ◽  
Seter Siziya ◽  
Victor Daka ◽  
Elijah Kabelenga ◽  
Ruth L. Mfune ◽  
...  
Keyword(s):  
Adverse Events ◽  
Male Circumcision ◽  
Associated Factors ◽  
Cross Sectional Study ◽  
World Health ◽  
Voluntary Medical Male Circumcision ◽  
Adult Males ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Male Circumcision

Background Voluntary Medical Male Circumcision (VMMC) is a key intervention in HIV/AIDS. Improving VMMC program uptake in Zambia requires careful monitoring of adverse events (AE) to inform program quality and safety. We investigate the prevalence of VMMC AE and their associated factors among adult males in Ndola, Copperbelt Province, Zambia. Methods We performed a cross-sectional study using secondary clinical data collected in 2015 using two validated World Health Organisation/Ministry of Health reporting forms. We reviewed demographics and VMMC surgical details from 391 randomly sampled adult males aged ≥18 years at Ndola Teaching Hospital, a specialised VMMC fixed site in Zambia. Non-parametric tests (Fisher’s exact test or Chi-square depending on assumptions being met) and logistic regression were conducted to determine the relationships between associated factors and VMMC AE. Results The overall VMMC AE prevalence was 3.1% (95% CI 1.60%– 5.30%) and most AEs occurred postoperatively. In decreasing order, the commonly reported VMMC AE included; bleeding (47.1%), swelling (29.4%), haematoma (17.6%), and delayed wound healing (5.9%). There was an inversely proportional relationship between VMMC volume (as measured by the number of surgeries conducted per VMMC provider) and AEs. Compared to the highest VMMC volume of 63.2% (247/391) as reference, as VMMC volume reduced to 35.0% (137/391) and then 1.8% (7/391), the likelihood of AEs increased by five times (aOR 5.08; 95% CI 1.33–19.49; p = 0.018) and then sixteen times (aOR 16.13; 95% CI 1.42–183.30; p = 0.025) respectively. Conclusions Our study found a low prevalence of VMMC AEs in Ndola city, Copperbelt Province of Zambia guaranteeing the safety of the VMMC program. We recommend more surgically proficient staff to continue rendering this service. There is a need to explore other high priority national/regional areas of VMMC program safety/quality, such as adherence to follow-up visits.

scholarly journals Voluntary Medical Male Circumcision and Sexual Practices among Sexually Active Circumcised Men in Mzuzu, Malawi: A Cross-Sectional Study

2019 ◽  
Author(s):  
Zimveka Jones Chatsika ◽  
Andrew Kumitawa ◽  
Vincent Samuel ◽  
Steven Chifundo Azizi ◽  
Vincent C Jumbe
Keyword(s):  
Protective Effect ◽  
Male Circumcision ◽  
Cross Sectional Study ◽  
Sexual Practices ◽  
Voluntary Medical Male Circumcision ◽  
Low Density ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Male Circumcision ◽  
Risky Sexual Practices

Abstract Background Voluntary Medical Male Circumcision (VMMC) is one of the strategies being promoted to prevent sexual heterosexual transmission of HIV. It has been adopted by 14 countries with high HIV prevalence and low circumcision rates. The 60% protective efficacy of VMMC has come with misconceptions in some societies in Malawi, hence VMMC clients may opt for risky sexual practices owing to its perceived protective effect. The study estimated proportion of circumcised men engaging in risky sexual behaviors post-VMMC, assessed knowledge on VMMC protective effect and identified socio-demographic factors associated with risky sexual practices. Method A cross sectional study was conducted at two sites of Mzuzu city. Systematic random sampling was used to select 322 clients aged 18-49 who had undergone VMMC. The independent variables included age, location, occupation, religion, marital status and education. Outcome variables were non condom use, having multiple sexual partners and engaging in transactional sex. Data from questionnaires was analyzed using Pearson’s chi square test and logistic regression. Results Out of 322 respondents, 84.8% (273) understood the partial protection offered by VMMC in HIV prevention. Ninety-six percent of the participants self-reported continued use of condoms post VMMC. Overall 23.7% - 38.3% clients self-reported engaging in risky sexual practices post VMMC, 23.7% (76) had more than one sexual partner; 29.2% (94) paid for sex while 39.9% (n=187) did not use a condom. Residing in high density areas was associated with non-condom use, (p = 0.043). Being single (p <0.0001), and residing in low density areas (p = 0.004) was associated with engaging in transactional sex. Conclusion Risky sexual practices are evident among clients that have undergone VMMC. Messages on safer sexual practices and limitations of VMMC need to be emphasized to clients, especially unmarried or single and those residing in low density areas.

scholarly journals Innovative demand creation strategies to increase voluntary medical male circumcision uptake: a pragmatic randomised controlled trial in Zimbabwe

2021 ◽  
Vol 6 (Suppl 4) ◽  
pp. e006141
Author(s):  
Webster Mavhu ◽  
Melissa Neuman ◽  
Karin Hatzold ◽  
Stephen Buzuzi ◽  
Galven Maringwa ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Interpersonal Communication ◽  
Male Circumcision ◽  
Controlled Trial ◽  
Final Analysis ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Demand Creation ◽  
Randomised Controlled ◽  
The Impact

IntroductionReaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary medical male circumcision (VMMC) remains a challenge. We assessed the impact of two VMMC demand creation approaches targeting this age group in a randomised controlled trial (RCT).MethodsWe conducted a 2×2 factorial RCT comparing arms with and without two interventions: (1) standard demand creation augmented by human-centred design (HCD)-informed approach; (2) standard demand creation plus offer of HIV self-testing (HIVST). Interpersonal communication (IPC) agents were the unit of randomisation. We observed implementation of demand creation over 6 months (1 May to 31 October 2018), with number of men circumcised assessed over 7 months. The primary outcome was the number of men circumcised per IPC agent using the as-treated population of actual number of months each IPC agent worked. We conducted a mixed-methods process evaluation within the RCT.ResultsWe randomised 140 IPC agents, 35 in each arm. 132/140 (94.3%) attended study training and 105/132 (79.5%) reached at least one client during the trial period and were included in final analysis. There was no evidence that the HCD-informed intervention increased VMMC uptake versus no HCD-informed intervention (incident rate ratio (IRR) 0.87, 95% CI 0.38 to 2.02; p=0.75). Nor did offering men a HIVST kit at time of VMMC mobilisation (IRR 0.65, 95% CI 0.28 to 1.50; p=0.31). Among IPC agents that reported reaching at least one man with demand creation, both the HCD-informed intervention and HIVST were deemed useful. There were some challenges with trial implementation; <50% of IPC agents converted any men to VMMC, which undermined our ability to show an effect of demand creation and may reflect acceptability and feasibility of the interventions.ConclusionThis RCT did not show evidence of an effect of HCD-informed demand intervention or HIVST on VMMC uptake. Findings will inform future design and implementation of demand creation evaluations.Trial registration numberPACTR201804003064160.

scholarly journals The impact of market segmentation and social marketing on uptake of preventive programmes: the example of voluntary medical male circumcision. A literature review

2018 ◽  
Vol 2 ◽  
pp. 68 ◽  
Author(s):  
Anabel Gomez ◽  
Rebecca Loar ◽  
Andrea England Kramer
Keyword(s):  
Market Segmentation ◽  
Male Circumcision ◽  
Service Providers ◽  
Behavioural Change ◽  
Full Potential ◽  
Voluntary Medical Male Circumcision ◽  
Global Development ◽  
Medical Male Circumcision ◽  
Business World ◽  
The Impact

Background: The business world has long recognized the power of defining discrete audiences within a target population. However, market segmentation’s full potential has not been applied to the public health context. While some broad elements of market segmentation (e.g., age, geography) are considered, a nuanced look at behavioural and psychographic segmentation, which could greatly enhance the possibility of lasting behaviour change, is often missing.   Segmentation, and the associated mindset which acknowledges the multi-dimensional differences between people, allows service providers, implementers, policymakers, and government officials to target initiatives and lead to a greater likelihood of lasting behavioural change. This paper investigates what segmentation is, how it has been applied to voluntary medical male circumcision (VMMC), how it can be applied in development, and the challenges in both measuring and adopting segmentation as part of program design. Methods: We performed a detailed search of peer-reviewed literature using PubMed, ProQuest, ScienceDirect, Google Scholar, and the abstract directories of the International AIDS Society (IAS) published between January 2015 and September 2018. We also accessed articles from business databases such as the Harvard Business Review.   Results: Results from a VMMC-focused intervention that successfully designed and delivered segmentation-based programs in two countries demonstrated that it is possible to adapt private sector approaches. However, within the sector of global development that is most familiar with segmentation, these efforts rarely go beyond basic demographic segments. Conclusions: Existing published material tends not to measure the impact of segmentation itself, but the impact of the intervention to which segmentation was applied, which makes it challenging for the development sector to invest in the approach without evidence that it works. Nonetheless, the experiences of segmentation and demand creation for VMMC do highlight the opportunity for better integrating this approach in HIV prevention and in global development and measurement initiatives.

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