Kim Hana, Branscum Adam, Miller F DeWolfe, Cuadros Diego F
Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Biostatistics, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA.
BMJ Glob Health. 2019 Nov 5;4(6):e001922. doi: 10.1136/bmjgh-2019-001922. eCollection 2019.
Tanzania is one of the 14 priority countries in sub-Saharan Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention. In this study, we assessed the progress of VMMC by evaluating changes in the spatial structure of male circumcision (MC) prevalence and identifying age groups with low MC uptake.
We use data from two waves of the Demographic and Health Survey (DHS) conducted in Tanzania in 2011-2012 and 2015-2016. MC incidence rate was estimated using a method developed to calculate incidence rates from two successive cross-sectional surveys. Continuous surface maps of MC prevalence were generated for both DHS waves and compared with identified areas with high MC prevalence changes and high density of uncircumcised males.
National MC prevalence in Tanzania increased from 73.5% in 2011-2012 to 80.0% in 2015-2016. The estimated national MC incidence rate was 4.6 circumcisions per 100 person-years (py). The lowest circumcision rate was observed in males aged 20-24 years, with 0.61 circumcisions per 100 py. An estimated 1 567 253 males aged 15-49 years residing in low-MC prevalence areas were uncircumcised in 2015-2016.
Tanzania has shown substantial progress in the implementation of VMMC. However, extensive spatial variation of MC prevalence still exists in the country, with some areas having an MC prevalence <60%. Here, we identified locations where VMMC needs to be intensified to reach the ~1.5 million uncircumcised males age 15-49 living in these low-MC areas, particularly for men aged 20-34.
坦桑尼亚是撒哈拉以南非洲地区14个扩大自愿男性包皮环切术（VMMC）以预防艾滋病毒的重点国家之一。在本研究中，我们通过评估男性包皮环切术（MC）流行率的空间结构变化并确定MC接受率较低的年龄组，来评估VMMC的进展情况。
我们使用了2011 - 2012年和2015 - 2016年在坦桑尼亚进行的两轮人口与健康调查（DHS）的数据。MC发病率采用一种为从两次连续横断面调查计算发病率而开发的方法进行估计。为这两轮DHS生成了MC流行率的连续表面地图，并与MC流行率变化高和未包皮环切男性密度高的已确定区域进行比较。
坦桑尼亚的全国MC流行率从2011 - 2012年的73.5%上升至2015 - 2016年的80.0%。估计全国MC发病率为每100人年4.6例包皮环切术。在20 - 24岁男性中观察到最低的包皮环切率，每100人年为0.61例包皮环切术。2015 - 2016年，估计有1567253名年龄在15 - 49岁、居住在MC低流行率地区的男性未进行包皮环切。
坦桑尼亚在实施VMMC方面已取得显著进展。然而，该国MC流行率仍存在广泛的空间差异，一些地区的MC流行率<60%。在此，我们确定了需要加强VMMC的地点，以覆盖生活在这些MC低流行地区的约150万年龄在15 - 49岁的未包皮环切男性，特别是20 - 34岁的男性。
