通过同伴教育和激励措施提高津巴布韦东马绍纳兰省男性自愿性医学包皮环切术的风险感知和参与率：一项试点随机试验研究方案。

Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, East Zimbabwe: study protocol for a pilot randomised trial.

机构信息

Department of Health Policy, London School of Economics and Political Science, Cowdray House, London, WC2 2AE, UK.

Section of Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5 opg, B, Postb 15, Building: 15.0.17, 1014, København K, Denmark.

出版信息

Trials. 2020 Jan 23;21(1):108. doi: 10.1186/s13063-020-4048-2.

DOI:10.1186/s13063-020-4048-2

PMID:31973744

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6979356/

Abstract

BACKGROUND

Voluntary medical male circumcision (VMMC) is a key component of combination HIV-prevention programmes. Several high-HIV-prevalence countries in sub-Saharan Africa, including Zimbabwe, are looking to scale up VMMC activities. There is limited evidence on how a combination of social learning from peer education by a role model with different behavioural incentives influences demand for VMMC in such settings.

METHODS/DESIGN: This matched-cluster randomised controlled trial with 1740 participants will compare two behavioural incentives against a control with no intervention. In the intervention clusters, participants will participate in an education session delivered by a circumcised young male ("role model") on the risks of HIV infection and the benefits from medical male circumcision. All participants will receive contributions towards transport costs to access medical male circumcision at participating clinics. Via blocked randomisation, in the intervention clusters participants will be randomly assigned to receive one of two types of incentives - fixed cash payment or lottery payment - both conditional on undergoing surgical VMMC. In two sites, a community-led intervention will also be implemented to address social obstacles and to increase support from peers, families and social structures. Baseline measures of endpoints will be gathered in surveys. Follow-up assessment at 6 months will include self-reported uptake of VMMC triangulated with clinic data.

DISCUSSION

This is the first trial to pilot-test social learning to improve risk perception and self-efficacy and to address the fear of pain associated with VMMC and possible present-biased preferences with front-loaded compensations as well as fixed or lottery-based cash payments. This study will generate important knowledge to inform HIV-prevention policies about the effectiveness of behavioural interventions and incentives, which could be easily scaled-up.

TRIAL REGISTRATION

This trial has been registered on ClinicalTrials.gov (identifier: NCT03565588). Registered on 21 June 2018.

摘要

背景

自愿男性包皮环切术（VMMC）是组合式 HIV 预防方案的重要组成部分。撒哈拉以南非洲的几个高 HIV 流行国家，包括津巴布韦，都在寻求扩大 VMMC 活动。在这种情况下，关于榜样的同伴教育中的社会学习与不同行为激励相结合如何影响对 VMMC 的需求，证据有限。

方法/设计：这是一项针对 1740 名参与者的匹配群组随机对照试验，将比较两种行为激励措施与无干预的对照组。在干预组中，参与者将参加由已接受环切的年轻男性（“榜样”）提供的关于 HIV 感染风险和接受医学男性包皮环切术益处的教育课程。所有参与者都将获得交通费用补贴，以在参与诊所接受男性包皮环切术。通过分组随机化，在干预组中，参与者将随机分配接受两种类型的激励之一-固定现金支付或彩票支付-两者均以接受手术 VMMC 为条件。在两个地点，还将实施社区主导的干预措施，以解决社会障碍问题，并增加来自同伴、家庭和社会结构的支持。将在调查中收集终点的基线措施。6 个月的随访评估将包括自我报告的 VMMC 使用率，与诊所数据进行三角测量。