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Dissemination and implementation of an evidence-based voluntary medical male circumcision program: The Spear & Shield program.

作者信息

Weiss Stephen M, Bowa Kasonde, Zulu Robert, Rodriguez Violeta J, Cook Ryan R, Jones Deborah L

机构信息

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America.

Clinical Sciences Department University of Lusaka, Lusaka, Zambia.

出版信息

PLOS Glob Public Health. 2024 Jan 31;4(1):e0002065. doi: 10.1371/journal.pgph.0002065. eCollection 2024.


DOI:10.1371/journal.pgph.0002065
PMID:38295087
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10830021/
Abstract

Despite compelling evidence linking voluntary medical male circumcision (VMMC) with 60-70% HIV risk reduction in sub-Saharan Africa, Zambian men have been especially reluctant to undergo VMMC. The Government of Zambia set targets for VMMC uptake and promoted community-level interventions. Spear & Shield (S&S) is an innovative, evidence-based, service program promoting VMMC uptake while ensuring both VMMC supply and demand. This study assessed the large-scale provincial rollout of the program (S&S2) utilizing the RE-AIM model for translating interventions into the community. The S&S2 study was conducted between November 2015 and December 2020, and sequentially rolled out over four Zambian provinces in 96 clinics; 24 observation clinics received VMMC training only. Local clinic healthcare workers were trained to conduct the VMMC procedure and HIV counselors were trained to lead S&S group sessions. Using the RE-AIM model, primary outcomes were: Reach, the number, proportion, and representativeness of S&S attendees; Effectiveness, the impact of S&S2 on VMMC uptake; Adoption, the number, proportion, and representativeness of clinics implementing S&S2; Implementation, fidelity to the S&S intervention manual; and Maintenance, the extent to which S&S2 became an element of standard care within community clinics. Initially, n = 109 clinics were recruited; 96 were sustained and randomized for activation (Adoption). A total of 45,630 clinic patients (n = 23,236 men and n = 22,394 women) volunteered to attend the S&S sessions (Reach). The S&S2 program ran over 2,866 clinic-months (Implementation). Although the study did not target individual-level VMMCs, ~58,301 additional VMMCs were conducted at the clinic level (Effectiveness). Fidelity to the S&S intervention by group leaders ranged from 42%-95%. Sustainability of the program was operationalized as the number of CHCs initially activated that sustained the program. Intervention delivery ended, however, when study funding ceased (Maintenance). The S&S2 program successfully utilized the RE-AIM model to achieve study goals for implementation and dissemination in four Zambian provinces. Innovative VMMC programs such as S&S2 can improve the uptake of VMMC, one of the most effective strategies in the HIV prevention arsenal.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5c8/10830021/47396efdaf35/pgph.0002065.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5c8/10830021/ea4e403ea551/pgph.0002065.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5c8/10830021/47396efdaf35/pgph.0002065.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5c8/10830021/ea4e403ea551/pgph.0002065.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5c8/10830021/47396efdaf35/pgph.0002065.g002.jpg

相似文献

[1]
Dissemination and implementation of an evidence-based voluntary medical male circumcision program: The Spear & Shield program.

PLOS Glob Public Health. 2024-1-31

[2]
Understanding barriers and facilitators to voluntary medical male circumcision and Spear and Shield uptake in Zambian community health centers.

Transl Behav Med. 2022-5-26

[3]
Dissemination of the Spear & Shield Project using a Training of Trainers Model: A reflection on challenges and successes.

Transl Behav Med. 2022-5-26

[4]
Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project.

Glob Health Sci Pract. 2015-12-17

[5]
Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project.

AIDS Behav. 2016-11

[6]
Increasing acceptability and uptake of voluntary male medical circumcision in Zambia: implementing and disseminating an evidence-based intervention.

Transl Behav Med. 2018-11-21

[7]
Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project.

Int J Behav Med. 2015-12

[8]
Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis.

PLoS One. 2017-1-24

[9]
Voluntary medical male circumcision: a framework analysis of policy and program implementation in eastern and southern Africa.

PLoS Med. 2011-11-29

[10]
Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe.

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本文引用的文献

[1]
Cost-effectiveness of voluntary medical male circumcision for HIV prevention across sub-Saharan Africa: results from five independent models.

Lancet Glob Health. 2023-2

[2]
Dissemination of the Spear & Shield Project using a Training of Trainers Model: A reflection on challenges and successes.

Transl Behav Med. 2022-5-26

[3]
Understanding barriers and facilitators to voluntary medical male circumcision and Spear and Shield uptake in Zambian community health centers.

Transl Behav Med. 2022-5-26

[4]
Identifying factors associated with successful implementation and uptake of an evidence-based voluntary medical male circumcision program in Zambia: the Spear and Shield 2 Program.

Transl Behav Med. 2020-10-8

[5]
The effect of demand-side financial incentives for increasing linkage into HIV treatment and voluntary medical male circumcision: A systematic review and meta-analysis of randomised controlled trials in low- and middle-income countries.

PLoS One. 2018-11-14

[6]
Increasing acceptability and uptake of voluntary male medical circumcision in Zambia: implementing and disseminating an evidence-based intervention.

Transl Behav Med. 2018-11-21

[7]
The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial.

Lancet HIV. 2015-5

[8]
Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project.

AIDS Behav. 2016-11

[9]
Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project.

Int J Behav Med. 2015-12

[10]
World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

JAMA. 2013-11-27

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