肯尼亚尼亚扎罗地区提高 25-39 岁男性接受自愿男性割礼比例的策略：一项整群随机对照试验（TASCO 研究）的结果。

Strategies to increase uptake of voluntary medical male circumcision among men aged 25-39 years in Nyanza Region, Kenya: Results from a cluster randomized controlled trial (the TASCO study).

机构信息

Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, Washington, United States of America.

出版信息

PLoS One. 2023 Feb 3;18(2):e0276593. doi: 10.1371/journal.pone.0276593. eCollection 2023.

DOI:10.1371/journal.pone.0276593

PMID:36735665

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9897540/

Abstract

INTRODUCTION

Voluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region.

MATERIALS AND METHODS

We conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome.

RESULTS

At baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67.

DISCUSSION

Using these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years.

TRIAL REGISTRATION

clinicaltrials.gov identifier: NCT02497989.

摘要

引言

2008 年，肯尼亚纳安萨地区开始推行自愿男性包皮环切术（VMMC）以预防艾滋病。到 2014 年，已经进行了大约 80 万例 VMMC，其中 84.9%是 15-24 岁的男性。我们评估了人际沟通（IPC）和专门服务点（DSO）对纳安萨地区 25-39 岁男性 VMMC 接种率的影响。

材料与方法

2014 年 5 月至 2016 年 6 月，我们在纳安萨地区的 45 个行政地点（集群）进行了一项集群随机对照试验，参与者为 25-34 岁未行包皮环切的男性。在第一组中，使用 IPC 工具包来解决 VMMC 的障碍。在第二组中，将男性转介到经过修改以满足其偏好的 DSO。第三组结合了 IPC 和 DSO 组，第四组是标准护理（SOC）。在地点层面（每组 11-12 个）进行随机化。主要结局是三个月内接受 VMMC 的登记男性比例。使用广义估计方程评估干预措施对结局的影响。

结果

基线时，共对 9238 户有 25-39 岁男性的家庭进行了计数，对 9679 名男性进行了评估，其中 2792 名（28.8%）符合条件。有 577 名男性登记参加 IPC 组，825 名参加 DSO 组，723 名参加 IPC+DSO 联合组，667 名参加 SOC 组。SOC 组中男性 VMMC 接种率为 3.2%。IPC、DSO 和 IPC+DSO 联合组的 VMMC 接种率分别为 3.3%、4.5%和 4.4%。与 SOC 相比，研究组中 VMMC 接种的调整优势比（aOR）分别为 IPC aOR = 1.03；95%CI：0.50-2.13，DSO aOR = 1.31；95%CI：0.67-2.57，IPC+DSO 联合 aOR = 1.31，95%CI：0.65-2.67。