MALE CIRCUMCISION FOR HIV PREVENTION IN KENYA: EFFECTIVE STRATEGIES TO RECRUIT OL

标题：肯尼亚男性包皮环切术预防艾滋病毒：寻求有效战略 招募年纪较大的男性 背景：在肯尼亚，有140-160万人感染艾滋病毒，成人感染率为 6.3%。Nyanza是八个省之一，患病率最高，为13.9%。在Nyanza， 占主导地位的罗族聚居区的艾滋病毒流行情况 这一比例为20.2%(男性17.1%，女性22.8%)。几个驱动因素 除其他因素外，该省艾滋病毒快速传播的主要原因之一是缺乏 男性包皮环切术。大量的观察性研究和三个随机对照 试验一致认为，男性包皮环切术通过以下方式降低感染艾滋病毒的风险 大约60%。在公布这些结果并随后得到 世界卫生组织，肯尼亚从10月开始推出男性包皮环切术(MC)服务 2008年，到2011年3月，尼扬萨省已有250,807人接受了割礼，其中115,196人 由我们的组织执行。然而，接受服务的老年男子(25岁) 更容易感染艾滋病毒的人一直难以捉摸。我们建议评估不同的战略，以 招募25-39岁的男性--个人间通信(IPC)，有条件的现金转移 (CCT)，以及IPC和CCT的组合--在Nyanza的MC摄入量和成本方面。 目标和目标：目标是让80%的25-39岁男性接受割礼，具体是 目的是：i)评估四类25-39岁男性接受MC服务的比率 年：接触CCT的人与接触IPC的人与同时接触两种干预措施的人 合并与不接受干预的成本；ii)确定提供MC的成本 三种干预措施与不干预措施；iii)通过匿名检测来自 切除包皮，拒绝手术前检测的男性感染艾滋病毒的比例； 以及iv)将在MC环境中检测呈阳性的80%的人与艾滋病毒护理和治疗方案联系起来。 方法：将实施和评估三种招聘方法：IPC、CCT和a 两者的结合。根据IPC，我们将雇用那些接受过割礼的女性 冠军、工作场所冠军和意见领袖进行一对一和小组讨论 招聘和推荐到我们的MC服务网站；根据CCT，配偶或成年家庭成员 将陪同客户进行MC服务，并将向HTC和MC夫妇提供 有配偶的客户。手术后，配偶/家庭成员将获得一张价值 Kshs.每天1,750英镑(23美元)，为期一周。这套邮票将在香港的指定商店发售 在养家糊口的人康复期间交换食物供家庭使用； 将IPC和CCT结合起来，两种干预措施一起实施的效果将是 检查；在控制区，不会实施任何干预。建议的研究是 在几个方面独一无二：给定MC是一次性干预，使用现金激励来增加 采用这些服务将带来回报，因为它能更快地对人口产生影响； 利用当地资源和现有社区结构促进公共卫生将确保 可持续性；向配偶转移现金将促进妇女参与决策-- 对他们的配偶进行包皮环切。我们预计，在一年内， 在过去的21年半里，年龄在25岁至39岁之间的男性接受了割礼，年龄从10,519人增加到21,038人，其中 IPC、CCT和IPC/CCT干预的贡献比分别为1：1.5：2。

Title: Male Circumcision for HIV Prevention in Kenya: Seeking effective strategies to recruit older men Background: In Kenya, 1.4-1.6 million people are living with HIV, with an adult prevalence of 6.3%. Nyanza, one of the eight provinces, has the highest prevalence, at 13.9%. Within Nyanza, HIV prevalence in the districts occupied by the Luo - the dominant ethnic community in the province and third nationally - was 20.2% (17.1% in men and 22.8% in women). Several drivers of the rapid spread of HIV in the province have been identified as, among other factors, lack of male circumcision. A large number of observational studies and three randomized controlled trials concurred in their findings, that male circumcision reduces the risk of acquiring HIV by about 60%. Following the publications of these results and subsequent endorsement by the World Health Organization, Kenya rolled out male circumcision (MC) services from October 2008, and by March 2011, had circumcised 250,807 people in Nyanza province, 115,196 of these performed by our organization. However, uptake of services by older men (aged >25 years) who are more at risk of acquiring HIV has been elusive. We propose to evaluate different strategies to recruit men aged 25-39 years - Inter-Personal Communication (IPC), Conditional Cash Transfer (CCT), and a combination of IPC and CCT - in terms of uptake and cost of MC in Nyanza. Goal and Aims: With a goal of getting 80% of men aged 25-39 years circumcised, the specific aims are to: i) assess the rate of uptake of MC services among four categories of men aged 25-39 years: those exposed CCT vs. those exposed to IPC vs. those exposed to both interventions combined vs. those receiving no intervention; ii) determine the cost of providing MC among the three interventions vs. no intervention; iii) determine, through anonymous testing blood from the excised foreskin, the proportion of men who decline pre-operative testing who are HIV infected; and iv) link 80% of those who test positive in MC settings to HIV care and treatment programs. Methods: Three recruitment approaches will be implemented and evaluated: IPC, CCT and a combination of the two. Under IPC, we will engage those who have been circumcised, female champions, work-place champions, and opinion leaders to conduct one-on-one and small-group recruitment and referrals to our MC service sites; Under CCT, spouses or adult family members will accompany clients for MC services and couple HTC and MC education will be offered to clients with spouses. After surgery, the spouse/family member will be given a food stamp worth KShs. 1,750 (USD 23) per day for one week. The stamp will be presented to a designated shop in exchange of food stuff for use by the family when the bread-winner is recovering; Under Combined IPC and CCT, the effect of both interventions implemented together will be examined; In the Control District, no intervention will be implemented. The proposed study is unique in several ways: given MC is a one-off intervention, using cash incentives to increase the uptake of the services would pay off in terms of achieving faster population level impact; utilizing local resources and existing community structures to promote public health will ensure sustainability; and cash transfer to the spouse will promote women's involvement in decision- making around circumcision of their spouses. We anticipate doubling, in one year, the number of men age 25-39 years circumcised over the last 21/2 years, from 10,519 to 21,038, with a contributory ratio of 1:1.5:2 by IPC, CCT and IPC/CCT interventions, respectively.