The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial.
The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial.
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DOI：
10.1016/s2352-3018(15)00042-9
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发表时间：
2015-05
期刊：
影响因子：
--
通讯作者：
Chitalu N
中科院分区：
文献类型：
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作者：
Weiss SM;Zulu R;Jones DL;Redding CA;Cook R;Chitalu N
在非洲广泛开展自愿医疗男性包皮环切术（VMMC）可以在未来10年内避免约34.36亿艾滋病毒感染和30万人死亡。然而，大多数赞比亚男子对接受VMMC几乎没有兴趣。这项研究测试了旨在增加这些“难以接触”的男性对VMMC需求的干预措施的效果。这项随机对照试验于2012年至2014年在赞比亚卢萨卡（HIV患病率= 20·8%）进行。13个社区卫生中心（CHCs）分层艾滋病毒自愿咨询和检测（VCT）率和病人普查，并随机分配（5：5：3）到实验，控制或观察条件。所有13个地点的CHC保健提供者都接受了VMMC培训。试验统计学家不参与随机化。招募了800名未经包皮环切的艾滋病毒感染者，VCT后的男性，每种情况400人;邀请女性伴侣参加。主要结局是干预后12个月VMMC的可能性。试验注册号为NCT 01688167。实验条件下的161名参与者与96名对照参与者相比接受了VMMC [调整的比值比= 2.45，95%CI =（1.24，4.90）p =.0166]。实验条件参与者中VMMC后避孕套的使用与基线相比增加，对照参与者中没有变化。未报告与参与研究相关的不良事件。矛和盾干预与VMMC培训相结合，与VMMC的数量显着增加，以及在“难以达到”赞比亚男子中使用避孕套。结果支持的重要性，全面的艾滋病毒预防计划，增加供应和需求VMMC服务。NIH/NIMH R01MH 095539。
Widespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention designed to increase demand for VMMC among these “hard to reach” men. This cluster randomized controlled trial was conducted from 2012 to 2014 in Lusaka, Zambia (HIV prevalence = 20·8%). 13 Community Health Centers (CHCs) were stratified by HIV voluntary counseling and testing (VCT) rates and patient census and randomly assigned (5:5:3) to Experimental, Control or Observation Only conditions. CHC health care providers at all 13 sites received VMMC training. Trial statisticians did not participate in randomization. 800 uncircumcised HIV-, post-VCT men, 400 per condition, were recruited; female partners were invited to participate. The primary outcome was the likelihood of VMMC by 12 months post-intervention. The trial registration is NCT 01688167. 161 participants in the Experimental condition underwent VMMC as compared to 96 Control participants [adjusted odds ratio = 2·45, 95% CI = (1·24, 4·90) p = ·0166]. Post-VMMC condom use among Experimental condition participants increased compared to baseline, with no change among Control participants. No adverse events related to study participation were reported. The Spear and Shield intervention combined with VMMC training was associated with a significant increase in the number of VMMCs performed as well as in condom use among “hard to reach” Zambian men. Results support the importance of comprehensive HIV prevention programs that increase supply of and demand for VMMC services. NIH/NIMH R01MH095539.