U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB, Nairobi, Kenya.
U.S. Centers for Disease Control and Prevention (CDC), Division of HIV & TB Atlanta, GA, United States of America.
PLoS One. 2021 Jul 15;16(7):e0254140. doi: 10.1371/journal.pone.0254140. eCollection 2021.
INTRODUCTION: Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevalence of male circumcision (MC) in the subsequent years. Results of initial DMPPT2 modeling included implausible MC prevalence estimates, of up to 100%, for age bands whose sustained high uptake of VMMC pointed to unmet needs. Therefore, we conducted a cross-sectional survey among adolescents and men aged 10-29 years to determine the population level MC prevalence, guide target setting for achieving the goal of 80% MC prevalence and for validating DMPPT2 modelled estimates. METHODS: Beginning July to September 2019, a total of 3,569 adolescents and men aged 10-29 years from households in Siaya, Kisumu, Homa Bay and Migori Counties were interviewed and examined to establish the proportion already circumcised medically or non-medically. We measured agreement between self-reported and physically verified circumcision status and computed circumcision prevalence by age band and County. All statistical were test done at 5% level of significance. RESULTS: The observed MC prevalence for 15-29-year-old men was above 75% in all four counties; Homa Bay 75.6% (95% CI [69.0-81.2]), Kisumu 77.9% (95% CI [73.1-82.1]), Siaya 80.3% (95% CI [73.7-85.5]), and Migori 85.3% (95% CI [75.3-91.7]) but were 0.9-12.4% lower than DMPPT2-modelled estimates. For young adolescents 10-14 years, the observed prevalence ranged from 55.3% (95% CI [40.2-69.5]) in Migori to 74.9% (95% CI [68.8-80.2]) in Siaya and were 25.1-32.9% lower than DMMPT 2 estimates. Nearly all respondents (95.5%) consented to physical verification of their circumcision status with an agreement rate of 99.2% between self-reported and physically verified MC status (kappa agreement p-value<0.0001). CONCLUSION: This survey revealed overestimation of MC prevalence from DMPPT2-model compared to the observed population MC prevalence and provided new reference data for setting realistic program targets and re-calibrating inputs into DMPPT2. Periodic population-based MC prevalence surveys, especially for established programs, can help reconcile inconsistencies between VMMC program uptake data and modeled MC prevalence estimates which are based on the number of procedures reported in the program annually.
简介：肯尼亚于 2008 年开始实施自愿男性包皮环切术（VMMC）以预防艾滋病毒，并于 2016 年采用决策者方案规划工具版本 2（DMPPT2），以模拟每年进行的包皮环切术对随后几年男性包皮环切率（MC）的人群流行率的影响。初步 DMPPT2 建模的结果包括不可信的 MC 流行率估计值，高达 100%，这表明某些年龄组的 VMMC 持续高吸收率表明存在未满足的需求。因此，我们对 10-29 岁的青少年和男性进行了横断面调查，以确定人群水平的 MC 流行率，为实现 80%的 MC 流行率目标和验证 DMPPT2 模型估计值提供指导。 方法：从 2019 年 7 月至 9 月，对来自 Siaya、Kisumu、Homa Bay 和 Migori 县家庭的总共 3569 名 10-29 岁的青少年和男性进行了访谈和检查，以确定已接受医学或非医学包皮环切术的比例。我们测量了自我报告和实际验证的割礼状况之间的一致性，并按年龄组和县计算了割礼流行率。所有统计检验均在 5%的显著性水平进行。 结果：四个县 15-29 岁男性的观察到的 MC 流行率均高于 75%；Homa Bay 为 75.6%（95%CI[69.0-81.2]），Kisumu 为 77.9%（95%CI[73.1-82.1]），Siaya 为 80.3%（95%CI[73.7-85.5]），Migori 为 85.3%（95%CI[75.3-91.7]），但比 DMPPT2 模型估计值低 0.9-12.4%。对于 10-14 岁的青少年，观察到的流行率范围从 Migori 的 55.3%（95%CI[40.2-69.5]）到 Siaya 的 74.9%（95%CI[68.8-80.2]），比 DMPPT2 估计值低 25.1-32.9%。几乎所有受访者（95.5%）都同意对他们的割礼状况进行实际验证，自我报告和实际验证的割礼状况之间的一致率为 99.2%（kappa 一致性 p 值<0.0001）。 结论：与观察到的人群 MC 流行率相比，这项调查显示 DMPPT2 模型高估了 MC 流行率，并为设定现实的方案目标和重新校准 DMPPT2 输入提供了新的参考数据。定期进行基于人群的 MC 流行率调查，特别是对于已建立的方案，有助于协调 VMMC 方案接受数据和基于每年报告的程序数量的模型 MC 流行率估计之间的不一致。
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