University of North Carolina Project-Malawi, Lilongwe, Malawi
Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Open. 2023 Oct 3;13(10):e072855. doi: 10.1136/bmjopen-2023-072855.
OBJECTIVE: To evaluate the effect a multistrategy demand-creation and linkage intervention on voluntary medical male circumcision (VMMC) uptake, time to VMMC and predictors of VMMC uptake among men with sexually transmitted infections (STIs). DESIGN: Pragmatic preinterventional and postinterventional quasi-experimental study combined with a prospective observational design. SETTING: A public and specialised STI clinic in Lilongwe, Malawi. POPULATION: Uncircumcised men who presented to the STI clinic. METHODS AND INTERVENTION: The intervention consisted of transport reimbursement ('R'), intensified health education ('I') and short-messaging services/telephonic tracing ('Te'), abbreviated (RITe). A preintervention phase was conducted at baseline while RITe was rolled-out in the intervention phase in a sequential manner called implementation blocks: 'I' only-block 1; 'I+Te'-block 2 and RITe-block 3. MAIN OUTCOME MEASURES: Primary: VMMC uptake and time to VMMC for the full intervention and for each block. Secondary: predictors of VMMC uptake. RESULTS: A total of 2230 uncircumcised men presented to the STI clinic. The mean age was 29 years (SD±9), 58% were married/cohabiting, HIV prevalence was 6.4% and 43% had urethral discharge. Compared with standard of care (8/514, 1.6%), uptake increased by 100% during the intervention period (55/1716, 3.2%) (p=0.048). 'I' (25/731, 113%, p=0.044) and RITe (17/477, 125%, p=0.044) significantly increased VMMC uptake. The median time to VMMC was shorter during the intervention period (6 days, IQR: 0, 13) compared with standard of care (15 days, IQR: 9, 18). There was no significant incremental effect on VMMC uptake and time to VMMC between blocks. Men with genital warts were 18 times more likely to receive VMMC (adjusted relative risk=18.74, 95% CI: 2.041 to 172.453). CONCLUSIONS: Our intervention addressing barriers to VMMC improved VMMC uptake and time to VMMC among uncircumcised men with STIs, an important subpopulation for VMMC prioritisation. TRIAL REGISTRATION NUMBER: NCT04677374.
目的：评估多策略需求创造和联系干预对性传播感染（STI）男性自愿性男性环切（VMMC）参与率、VMMC 时间和 VMMC 参与率预测因素的影响。
设计：预干预前和后干预准实验研究与前瞻性观察设计相结合。
地点：马拉维利隆圭的一家公共和专门的性传播感染诊所。
人群：未行包皮环切术的男性，他们就诊于性传播感染诊所。
方法和干预：干预措施包括交通报销（R）、强化健康教育（I）和短信服务/电话追踪（Te），简称 RITe。在基线时进行了预干预阶段，而 RITe 在干预阶段以称为实施块的顺序推出：“I”仅块 1；“I+Te”-块 2 和 RITe-块 3。
主要观察指标：主要指标：VMMC 参与率和 VMMC 的总时间，包括整个干预期间和每个块的时间。次要指标：VMMC 参与率的预测因素。
结果：共有 2230 名未行包皮环切术的男性就诊于性传播感染诊所。平均年龄为 29 岁（标准差±9），58%已婚/同居，HIV 患病率为 6.4%，43%有尿道分泌物。与标准护理（8/514，1.6%）相比，干预期间 VMMC 参与率增加了 100%（55/1716，3.2%）（p=0.048）。“I”（25/731，113%，p=0.044）和 RITe（17/477，125%，p=0.044）显著增加了 VMMC 参与率。与标准护理相比，干预期间 VMMC 的中位时间更短（6 天，IQR：0，13）。在 VMMC 参与率和时间方面，各块之间没有显著的递增效应。患有生殖器疣的男性接受 VMMC 的可能性增加了 18 倍（调整后的相对风险=18.74，95%置信区间：2.041 至 172.453）。
结论：我们的干预措施针对 VMMC 的障碍，提高了性传播感染未行包皮环切术男性的 VMMC 参与率和 VMMC 时间，这是 VMMC 优先考虑的一个重要亚人群。
试验注册：NCT04677374。
Sci Rep. 2023-2-9
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