Matoga Mitch M, Kudowa Evaristar, Chikuni Joachim, Tsidya Mercy, Tseka Jennifer, Ndalama Beatrice, Bonongwe Naomi, Mathiya Esther, Jere Edward, Yatina Dumbo, Kamtambe Blessings, Kapito Martin, Hosseinipour Mina C, Chasela Charles S, Jewett Sara
University of North Carolina Project, Lilongwe, Malawi.
Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Heath Sciences, University of the Witwatersrand, Johannesburg, South Africa.
medRxiv. 2024 Apr 4:2024.03.27.24304985. doi: 10.1101/2024.03.27.24304985.
Uptake of voluntary medical male circumcision (VMMC) remains a challenge in many settings. Innovative implementation strategies are required to scale-up VMMC uptake.
RITe was a multi-faceted intervention comprising transport reimbursement (R), intensified health education (IHE) and SMS/Telephone tracing (Te), which increased the uptake of VMMC among uncircumcised men with sexually transmitted infections (STIs) in Malawi. Using a concurrent exploratory mixed-method approach, we assessed the intervention's acceptability, feasibility and appropriateness among men with STIs and healthcare workers (HCWs) at Bwaila District Hospital. Participants completed Likert scale surveys and participated in-depth interviews (IDIs) and focus group discussions (FGDs). We calculated percentages of responses to survey items and summarized common themes using thematic analysis. Median scores and interquartile ranges (IQR) were calculated for acceptability, feasibility and appropriateness of each strategy at baseline and end-line and compared using the Wilcoxon signed rank test.
A total of 300 surveys, 17 IDIs and 4 FGDs were conducted with men and HCWs between baseline and end-line. The mean age for men in the survey was 29 years (SD ±8) and most were married/cohabiting (59.3%). Mean age for HCWs was 38.5 years (SD ±7), and most were female (59.1%). For acceptability, participants agreed that RITe was welcome, approvable, and likable. Despite participants agreeing that RITe was a good idea, culture and religion influenced appropriateness, particularly at baseline, which improved at end-line for Te and R. For feasibility, HCWs agreed that RITe was easy to implement, but expressed concerns that R (end-line median = 4, IQR: 2, 4) and Te (end-line median = 4, IQR: 4, 4), were resource intensive, hence unsustainable. Interviews corroborated the survey results. Participants reported that IHE provided important information, Te was a good reminder and R was attractive, but they reported barriers to R and Te such as electricity, limited access to phones and distrust in the government.
The RITe intervention was acceptable, feasible and appropriate. However, culture/religion and structural barriers affected perceptions of appropriateness and feasibility, respectively. Continued awareness raising on VMMC and addressing setting-specific structural factors are required to overcome barriers that impede demand-creation interventions for VMMC.
ClinicalTrials.gov identifier: NCT04677374. Registered on December 18, 2020.
在许多地区，自愿男性医学包皮环切术（VMMC）的接受率仍然是一项挑战。需要创新的实施策略来扩大VMMC的接受率。
RITe是一项多方面的干预措施，包括交通补贴（R）、强化健康教育（IHE）和短信/电话追踪（Te），该措施提高了马拉维患有性传播感染（STIs）的未割包皮男性对VMMC的接受率。我们采用同步探索性混合方法，在Bwaila区医院评估了该干预措施在患有性传播感染的男性和医护人员（HCWs）中的可接受性、可行性和适宜性。参与者完成了李克特量表调查，并参与了深入访谈（IDIs）和焦点小组讨论（FGDs）。我们计算了调查项目的回答百分比，并使用主题分析总结了共同主题。计算了每个策略在基线和终线时的可接受性、可行性和适宜性的中位数分数和四分位间距（IQR），并使用Wilcoxon符号秩检验进行比较。
在基线和终线之间，共对男性和医护人员进行了300次调查、17次深入访谈和4次焦点小组讨论。调查中男性的平均年龄为29岁（标准差±8），大多数已婚/同居（59.3%）。医护人员的平均年龄为38.5岁（标准差±7），大多数为女性（59.1%）。关于可接受性，参与者一致认为RITe是受欢迎的、可批准的和令人喜欢的。尽管参与者一致认为RITe是个好主意，但文化和宗教影响了适宜性，特别是在基线时，而对于Te和R，在终线时有所改善。关于可行性，医护人员一致认为RITe易于实施，但表示担心R（终线中位数 = 4，IQR：2，4）和Te（终线中位数 = 4，IQR：4，4）资源密集，因此不可持续。访谈证实了调查结果。参与者报告说IHE提供了重要信息，Te是一个很好的提醒，R很有吸引力，但他们报告了R和Te存在的障碍，如电力、电话使用受限以及对政府的不信任。
RITe干预措施是可接受的、可行的和适宜的。然而，文化/宗教和结构障碍分别影响了对适宜性和可行性的认知。需要持续提高对VMMC的认识并解决特定环境下的结构因素，以克服阻碍VMMC需求创造干预措施的障碍。
ClinicalTrials.gov标识符：NCT04677374。于2020年12月18日注册。
