Increasing Availability and Acceptability of Circumcision in Zambia

描述（由申请人提供）：在非洲南部和东部，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，可将男性感染艾滋病毒的风险降低50-60%。为响应世卫组织关于制定国家规划以促进包皮环切的建议，赞比亚卫生部制定了《国家男性包皮环切战略和实施计划（2010-2020年）》，目标是到2020年实施250万例包皮环切手术，或每年25万例包皮环切手术。然而，基于人群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，超过80%的人表示对接受男性包皮环切术作为艾滋病毒预防策略不感兴趣。[注：在过去的12个月里，只有25000例包皮环切手术]。要实现国家目标，将需要大幅度增加合格的提供包皮环切术的卫生保健提供者（从400人增加到1500人）（供应），并制定有效的社区一级行为改变干预措施，在人口中推广包皮环切术，作为一种可接受的减少艾滋病毒感染风险的手段（需求）。这个应用程序建议测试一个“生物行为伙伴关系”，同时提高包皮环切的可接受性和可用性在社区卫生中心水平。研究假设将检验包皮环切项目是否将循证性风险降低/促进包皮环切干预与有能力的社区生物医学包皮环切服务相结合：1)比单独提供生物医学包皮环切服务的项目更有可能实现实现赞比亚国家包皮环切计划目标所需的包皮环切率；2)在接受包皮环切的人中预防风险补偿/行为解除抑制这项创新研究的成果将在未来十年对整个南部和东部非洲的艾滋病毒预防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.