同伴推荐激励干预措施在赞比亚促进男性包皮环切术接受率的可行性与有效性
Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia.
作者信息
Zanolini Arianna, Bolton Carolyn, Lyabola Lane-Lee, Phiri Gabriel, Samona Alick, Kaonga Albert, Thirumurthy Harsha
机构信息
*Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; †Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Society for Family Health, Lusaka, Zambia; and §Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
出版信息
J Acquir Immune Defic Syndr. 2016 Aug 15;72 Suppl 4(Suppl 4):S257-63. doi: 10.1097/QAI.0000000000000808.
BACKGROUND
Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision.
METHODS
The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention.
RESULTS
During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised.
CONCLUSIONS
The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male circumcision. Barriers to circumcision and features of the intervention may have limited the effect of the intervention. Further efforts regarding encouraging male-to-male communication and evaluations with larger sample sizes are needed.
背景
在艾滋病普遍流行的国家，医学男性包皮环切术是一种很有前景的艾滋病预防工具，但需要开展需求激发干预措施以支持扩大规模。我们试点了一项同伴推荐干预措施，为接受包皮环切术的患者提供激励，鼓励他们推荐同伴接受包皮环切术。
方法
2014年6月至2015年2月期间，在赞比亚南部省随机选择的6家医疗机构实施了该干预措施。在最初的5个月里，年龄≥18岁的包皮环切术患者会收到转诊代金券，允许他们在3个月内推荐最多5名同伴接受包皮环切术。每成功推荐一名同伴，可获得2美元的奖励。主要结局是每个医疗机构每月进行的包皮环切术数量。为评估干预措施的效果，使用了来自干预医疗机构和22家非干预医疗机构的纵向数据进行差分分析。还实施了一项问卷调查，以了解男性对该干预措施的看法。
结果
在为期8个月的干预期间，干预医疗机构中有1222名18岁以上男性接受了包皮环切术。在最初的5个月里，有699名包皮环切术患者登记参与，其中385名患者带来了已登记患者给他们的转诊代金券。差分分析未显示干预医疗机构进行的包皮环切术数量有显著增加。然而，接受包皮环切术的患者报告称，转诊激励促使他们鼓励朋友寻求男性包皮环切术。同伴推荐也被报告为男性决策中的一个重要因素，因为78%被推荐的患者表示，与接受过包皮环切术的朋友交谈对他们决定接受包皮环切术很重要。
结论
男性包皮环切术的同伴推荐激励干预措施是可行且可接受的。然而，该干预措施对男性包皮环切术的需求没有显著影响。包皮环切术的障碍和干预措施的特点可能限制了干预效果。需要进一步努力鼓励男性之间的交流，并进行更大样本量的评估。
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