Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Sex Transm Infect. 2013 Aug;89(5):345-9. doi: 10.1136/sextrans-2012-050595. Epub 2013 May 22.
Three randomised trials demonstrate that voluntary medical male circumcision (MMC) reduces male HIV acquisition by 50-60%, and post-trial surveillance has shown that the effects are long lasting. Scale-up of services has been initiated in 14 high-priority sub-Saharan African countries with high rates of HIV and low prevalence of MMC. However, circumcision coverage in the region remains low. Challenges to MMC rollout include suboptimal demand among higher-risk men, the need to expand access and reduce costs of MMC through personnel task shifting and task sharing, assuring and maintaining a high quality of service provision, and the testing and introduction of non-surgical devices. In addition, early infant male circumcision has not been adequately evaluated in Africa. Here, we describe challenges to implementation and discuss the ongoing and future role of implementation and programme science in addressing such challenges.
三项随机对照试验证明，男性自愿性包皮环切术（MMC）可使男性 HIV 感染率降低 50-60%，并且试验后的监测显示其效果持久。在 14 个高优先级的撒哈拉以南非洲国家，这些国家 HIV 感染率高、MMC 普及率低，已经启动了服务扩大计划。然而，该地区的包皮环切术覆盖率仍然很低。推广 MMC 面临的挑战包括：高风险男性的需求不理想，需要通过人员任务转移和任务共享扩大 MMC 的可及性并降低成本，确保并维持高质量的服务提供，以及测试和引入非手术设备。此外，在非洲，早期对男婴进行包皮环切术的效果尚未得到充分评估。在这里，我们描述了实施过程中面临的挑战，并讨论了实施和规划科学在应对这些挑战中的当前和未来作用。
