World Health Organization, Geneva, Switzerland.
PLoS Med. 2011 Nov;8(11):e1001133. doi: 10.1371/journal.pmed.1001133. Epub 2011 Nov 29.
BACKGROUND: Following confirmation of the effectiveness of voluntary medical male circumcision (VMMC) for HIV prevention, the World Health Organization and the Joint United Nations Programme on HIV/AIDS issued recommendations in 2007. Less than 5 y later, priority countries are at different stages of program scale-up. This paper analyzes the progress towards the scale-up of VMMC programs. It analyzes the adoption of VMMC as an additional HIV prevention strategy and explores the factors may have expedited or hindered the adoption of policies and initial program implementation in priority countries to date. METHODS AND FINDINGS: VMMCs performed in priority countries between 2008 and 2010 were recorded and used to classify countries into five adopter categories according to the Diffusion of Innovations framework. The main predictors of VMMC program adoption were determined and factors influencing subsequent scale-up explored. By the end of 2010, over 550,000 VMMCs had been performed, representing approximately 3% of the target coverage level in priority countries. The "early adopter" countries developed national VMMC policies and initiated VMMC program implementation soon after the release of the WHO recommendations. However, based on modeling using the Decision Makers' Program Planning Tool (DMPPT), only Kenya appears to be on track towards achievement of the DMPPT-estimated 80% coverage goal by 2015, having already achieved 61.5% of the DMPPT target. None of the other countries appear to be on track to achieve their targets. Potential predicators of early adoption of male circumcision programs include having a VMMC focal person, establishing a national policy, having an operational strategy, and the establishment of a pilot program. CONCLUSIONS: Early adoption of VMMC policies did not necessarily result in rapid program scale-up. A key lesson is the importance of not only being ready to adopt a new intervention but also ensuring that factors critical to supporting and accelerating scale-up are incorporated into the program. The most successful program had country ownership and sustained leadership to translate research into a national policy and program. Please see later in the article for the Editors' Summary.
背景：在确认自愿男性包皮环切术（VMMC）在预防艾滋病毒方面的有效性之后，世界卫生组织和联合国艾滋病规划署于 2007 年发布了建议。不到 5 年之后，重点国家处于方案扩大规模的不同阶段。本文分析了 VMMC 方案扩大规模的进展。本文分析了将 VMMC 作为一项额外的艾滋病毒预防策略的采用情况，并探讨了可能加速或阻碍重点国家迄今为止采用政策和初始方案实施的因素。 方法和发现：记录了 2008 年至 2010 年在重点国家进行的 VMMC，并根据创新传播框架将这些国家分为五类采用者类别。确定了 VMMC 方案采用的主要预测因素，并探讨了影响后续扩大规模的因素。到 2010 年底，已完成超过 550,000 例 VMMC，占重点国家目标覆盖水平的约 3%。“早期采用者”国家在发布世卫组织建议后不久即制定了国家 VMMC 政策并启动了 VMMC 方案的实施。然而，根据使用决策者方案规划工具（DMPPT）进行建模的结果，只有肯尼亚似乎有望在 2015 年之前达到 DMPPT 估计的 80%的覆盖目标，目前已经实现了 DMPPT 目标的 61.5%。其他国家似乎都没有达到目标的迹象。男性包皮环切方案的早期采用的潜在预测因素包括有 VMMC 重点人物、制定国家政策、制定业务战略和建立试点方案。 结论：VMMC 政策的早期采用不一定导致方案迅速扩大规模。一个重要的经验教训是，不仅要准备采用新的干预措施，而且要确保将支持和加速扩大规模的关键因素纳入方案。最成功的方案是国家自主和持续的领导层，将研究转化为国家政策和方案。请在后文中查看编辑摘要。
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