坦桑尼亚青少年男性中与医学男性包皮环切术低接受率相关的因素：多项逻辑回归建模
Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling.
作者信息
Bendera Anderson, Nakamura Keiko, Seino Kaoruko, Al-Sobaihi Saber
机构信息
Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
HIV AIDS (Auckl). 2022 Dec 19;14:565-575. doi: 10.2147/HIV.S387380. eCollection 2022.
BACKGROUND
Human immunodeficiency virus (HIV) remains the leading cause of years of life lost among adolescent boys in eastern and southern Africa. Medical male circumcision (MMC) is a cost-effective one-time intervention that can reduce the risk of heterosexual HIV acquisition in men by approximately 60%. Despite its importance in HIV prevention, the uptake of MMC remains suboptimal among adolescent boys. This study aimed to identify factors associated with low MMC uptake among adolescent boys in Tanzania.
METHODS
This study was a secondary analysis of the 2016-17 Tanzania HIV Impact Survey. Descriptive statistics were used to summarize the participants' characteristics. Unadjusted and adjusted multinomial logistic regression models were fitted to identify factors associated with low MMC uptake among adolescent boys.
RESULTS
A total of 2605 older adolescents (15-19 years) and 1296 young adolescents (10-14 years) were analyzed. The MMC uptake rates among older and young adolescents were 56.5% and 45.1%, respectively. Lower MMC uptake was found among respondents in rural areas (adjusted relative risk ratio [aRRR] = 0.40, 95% CI: 0.28-0.57), in the traditionally non-circumcising zone (aRRR = 0.30, 95% CI: 0.23-0.41), participants with no formal education (aRRR = 0.32, 95% CI: 0.23-0.41), and those living in lower wealth quintile households (aRRR = 0.20, 95% CI: 0.11-0.36). Respondents who were not covered by health insurance (aRRR = 0.67, 95% CI: 0.48-0.94) and those who had no comprehensive HIV knowledge (aRRR = 0.55, 95% CI: 0.44-0.70) were also found to have lower uptake of MMC.
CONCLUSION
To achieve and maintain high MMC coverage, MMC interventions for HIV prevention should focus on uncircumcised adolescent boys who are rural residents, of lower socioeconomic status, and residing in traditionally non-circumcising communities. Furthermore, dissemination of HIV knowledge and increasing health insurance coverage may encourage more adolescent boys to undergo MMC.
背景
在东非和南部非洲，人类免疫缺陷病毒（HIV）仍然是导致青春期男孩寿命损失的主要原因。男性医学包皮环切术（MMC）是一种具有成本效益的一次性干预措施，可将男性通过异性性行为感染HIV的风险降低约60%。尽管MMC在HIV预防中具有重要意义，但青春期男孩对MMC的接受程度仍然不理想。本研究旨在确定坦桑尼亚青春期男孩MMC接受率低的相关因素。
方法
本研究是对2016 - 17年坦桑尼亚HIV影响调查的二次分析。使用描述性统计来总结参与者的特征。采用未调整和调整后的多项逻辑回归模型来确定与青春期男孩MMC接受率低相关的因素。
结果
共分析了2605名年龄较大的青少年（15 - 19岁）和1296名年龄较小的青少年（10 - 14岁）。年龄较大和较小青少年的MMC接受率分别为56.5%和45.1%。农村地区的受访者（调整后的相对风险比[aRRR]=0.40，95%置信区间：0.28 - 0.57）、传统上不进行包皮环切的地区（aRRR = 0.30，95%置信区间：0.23 - 0.41）、未接受过正规教育的参与者（aRRR = 0.32，95%置信区间：0.23 - 0.41）以及生活在财富五分位数较低家庭的人群（aRRR = 0.20，95%置信区间：0.11 - 0.36）的MMC接受率较低。未参加医疗保险的受访者（aRRR = 0.67，95%置信区间：0.48 - 0.94）和没有全面HIV知识的受访者（aRRR = 0.55，95%置信区间：0.44 - 0.70）的MMC接受率也较低。
结论
为了实现并维持较高的MMC覆盖率，用于HIV预防的MMC干预措施应侧重于农村居民、社会经济地位较低且居住在传统上不进行包皮环切社区的未接受包皮环切的青春期男孩。此外，传播HIV知识和提高医疗保险覆盖率可能会鼓励更多青春期男孩接受MMC。
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