Increasing Availability and Acceptability of Circumcision in Zambia

描述(由申请人提供)：在南部和东部非洲，男性包皮环切术(MC)已被证明是一种有效的艾滋病毒预防策略，将男性感染艾滋病毒的风险降低了50%-60%。为了响应世卫组织关于制定促进包皮环切术的国家方案的建议，赞比亚卫生部制定了国家男性包皮环切术战略和执行计划(2010-2020年)，目标是到2020年进行250万例包皮环切术，即每年25万例包皮环切术。然而，基于人口的赞比亚性行为调查(2010年)的最新证据表明，在88%的赞比亚男性人口中，没有接受割礼的人中，超过80%的人表示没有兴趣将男性割礼作为艾滋病毒预防策略。要实现国家目标，将需要大幅增加现有的合格保健提供者(从400人增加到1500人)来实施包皮环切术(供应)，并制定有效的社区一级行为改变干预措施，促进在人口中实施包皮环切术，以此作为降低艾滋病毒感染风险的可接受手段(需求)。该应用程序建议测试“生物行为伙伴关系”，以同时提高社区卫生中心层面的包皮环切术的可接受性和可用性。研究假设将测试包皮环切术计划是否将循证的性风险降低/MC促进干预与社区一级合格的生物医学MC服务相结合：1)与仅提供生物医学MC服务的方案相比，更有可能达到赞比亚国家包皮环切术计划的目标所需的包皮环切率；2)防止MC患者的风险补偿/行为去抑制。这项创新性研究的成功结果将对未来十年整个南部和东部非洲的艾滋病毒预防工作产生重大的政策影响。

DESCRIPTION (provided by applicant): Male circumcision (MC) has been proven to be a potent HIV prevention strategy in Southern and Eastern Africa, reducing risk of HIV acquisition in men by 50-60%. In response to WHO recommendations to establish national programs to promote MC, the Zambian Ministry of Health has created the National Male Circumcision Strategy and Implementation Plan (2010-2020), with the goal of performing 2.5 million circumcisions by 2020, or 250,000 circumcisions per year. However, recent evidence from the population-based Zambia Sexual Behaviour Survey (2010) indicates that of the 88% of the Zambian male population who are uncircumcised, over 80% express no interest in undergoing male circumcision as an HIV prevention strategy.[NB: only 25,000 circumcisions were performed over the past 12 months]. Reaching the national goal will require significantly increasing the available pool of qualified health care providers (from 400 to 1500) to perform circumcisions (supply), as well as developing effective community-level behavioral change interventions promoting circumcision among the population as an acceptable means of reducing risk of HIV infection (demand). This application proposes to test a "biobehavioral partnership" to simultaneously improve both circumcision acceptability and availability at the community health center level. Study hypotheses will test whether circumcision programs which combine an evidence-based sexual risk reduction/MC promotion intervention with competent biomedical MC services at the community level will 1) be more likely to achieve the rates of circumcision necessary to reach the goals of the Zambian National Circumcision Plan than those programs offering biomedical MC services alone while 2) preventing risk compensation/behavioral disinhibition among those undergoing MC. Successful outcomes from this innovative study will have major policy implications for HIV prevention across Southern and Eastern Africa over the next ten years.