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Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: A mixed methods study.

作者信息

Matoga Mitch M, Kudowa Evaristar, Tsidya Mercy, Tseka Jennifer, Ndalama Beatrice, Bonongwe Naomi, Mathiya Esther, Jere Edward, Yatina Dumbo, Kamtambe Blessings, Hosseinipour Mina C, Chasela Charles S, Jewett Sara

机构信息

University of North Carolina Project, Lilongwe, Malawi.

Implementation Science Unit, Right to Care, Pretoria, South Africa.

出版信息

PLoS One. 2025 Jan 24;20(1):e0301952. doi: 10.1371/journal.pone.0301952. eCollection 2025.


DOI:10.1371/journal.pone.0301952
PMID:39854431
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11760565/
Abstract

INTRODUCTION: Uptake of voluntary medical male circumcision (VMMC) remains a challenge in many settings. Innovative implementation strategies are required to scale-up VMMC uptake. METHODOLOGY: 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. RESULTS: 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, fit and suitability 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 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. CONCLUSIONS: 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.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/042d9de95df0/pone.0301952.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/a4cd699d76d7/pone.0301952.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/1bee9df69142/pone.0301952.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/042d9de95df0/pone.0301952.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/a4cd699d76d7/pone.0301952.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/1bee9df69142/pone.0301952.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1946/11760565/042d9de95df0/pone.0301952.g003.jpg

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[1]
Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: A mixed methods study.

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[2]
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本文引用的文献

[1]
Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010-2023-A systematic review and meta-analysis.

PLoS One. 2024

[2]
Effectiveness of an intervention to increase uptake of voluntary medical male circumcision among men with sexually transmitted infections in Malawi: a preinterventional and postinterventional study.

BMJ Open. 2023-10-3

[3]
'I understood the texting process well'. Participant perspectives on usability and acceptability of SMS-based telehealth follow-up after voluntary medical male circumcision in South Africa.

Digit Health. 2023-8-27

[4]
Factors Influencing the Uptake of Voluntary Medical Male Circumcision Among Boda-Boda Riders Aged 18-49 Years in Hoima, Western Uganda.

HIV AIDS (Auckl). 2022-9-23

[5]
Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi.

BMC Public Health. 2021-10-28

[6]
A randomized controlled trial evaluating combination detection of HIV in Malawian sexually transmitted infections clinics.

J Int AIDS Soc. 2021-4

[7]
The influence of branding on the uptake of voluntary medical male circumcision: a case study of "" in Lilongwe, Malawi.

Afr J AIDS Res. 2020-12

[8]
Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services.

Sex Transm Infect. 2021-8

[9]
Effects of HIV voluntary medical male circumcision programs on sexually transmitted infections.

Curr Opin Infect Dis. 2021-2-1

[10]
Perceived influence of value systems on the uptake of voluntary medical male circumcision among men in Kweneng East, Botswana.

SAHARA J. 2020-12

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