Evens Emily, Lanham Michele, Hart Catherine, Loolpapit Mores, Oguma Isaac, Obiero Walter
Health Services Research, FHI 360, Durham, North Carolina, United States of America.
Social and Behavioral Health Sciences, FHI 360, Durham, North Carolina, United States of America.
PLoS One. 2014 Jun 5;9(6):e98221. doi: 10.1371/journal.pone.0098221. eCollection 2014.
Uptake of VMMC among adult men has been lower than desired in Nyanza, Kenya. Previous research has identified several barriers to uptake but qualitative exploration of barriers is limited and evidence-informed interventions have not been fully developed. This study was conducted in 2012 to 1) increase understanding of barriers to VMMC and 2) to inform VMMC rollout through the identification of evidence-informed interventions among adult men at high risk of HIV in Nyanza Province, Kenya.
Focus groups (n = 8) and interviews were conducted with circumcised (n = 8) and uncircumcised men (n = 14) from the two districts in Nyanza, Kenya. Additional interviews were conducted with female partners (n = 20), health providers (n = 12), community leaders (n = 12) and employers (n = 12). Interview and focus group guides included questions about individual, interpersonal and societal barriers to VMMC uptake and ways to overcome them. Inductive thematic coding and analysis were conducted through a standard iterative process.
Two primary concerns with VMMC emerged 1) financial issues including missing work, losing income during the procedure and healing and family survival during the recovery period and 2) fear of pain during and after the procedure. Key interventions to address financial concerns included: a food or cash transfer, education on saving and employer-based benefits. Interventions to address concerns about pain included refining the content of demand creation and counseling messages about pain and improving the ways these messages are delivered.
Men need accurate and detailed information on what to expect during and after VMMC regarding both pain and time away from work. This information should be incorporated into demand creation activities for men considering circumcision. Media content should frankly and correctly address these concerns. Study findings support scale up and/or further improvement of these ongoing educational programs and specifically targeting the demand creation period.
在肯尼亚的尼扬扎省，成年男性对男性包皮环切术（VMMC）的接受程度低于预期。先前的研究已确定了接受该手术的若干障碍，但对这些障碍的定性探索有限，且基于证据的干预措施尚未充分开发。本研究于2012年开展，目的是：1）增进对VMMC障碍的理解；2）通过在肯尼亚尼扬扎省高HIV感染风险的成年男性中确定基于证据的干预措施，为VMMC的推广提供参考。
对来自肯尼亚尼扬扎省两个地区的接受过包皮环切术的男性（8人）和未接受过包皮环切术的男性（14人）进行了焦点小组访谈（共8组）和个体访谈。还对女性伴侣（20人）、医疗服务提供者（12人）、社区领袖（12人）和雇主（12人）进行了额外访谈。访谈和焦点小组指南包含有关接受VMMC的个人、人际和社会障碍以及克服这些障碍的方法的问题。通过标准的迭代过程进行归纳主题编码和分析。
出现了两个与VMMC相关的主要问题：1）财务问题，包括误工、手术及康复期间的收入损失以及家庭生计；2）对手术期间及术后疼痛的恐惧。解决财务问题的关键干预措施包括：提供食物或现金转移、储蓄教育以及基于雇主的福利。解决疼痛问题的干预措施包括完善有关疼痛的需求创造和咨询信息内容，以及改进这些信息的传递方式。
男性需要获得有关VMMC手术期间及术后在疼痛和误工方面预期情况的准确详细信息。该信息应纳入针对考虑接受包皮环切术男性的需求创造活动中。媒体内容应坦诚且正确地解决这些问题。研究结果支持扩大和/或进一步改进这些正在进行的教育项目，并特别针对需求创造阶段。
