GH11-005, Kenya: MALE CIRCUMCISION FOR HIV PREVENTION IN KENYA: EFFECTIVE STRATEGIES TO RECRUIT OL

GH11-005，肯尼亚：肯尼亚男性包皮环切术预防艾滋病毒：招募 OL 的有效策略

• 批准号: 8513781
• 负责人: Kawango Agot
• 金额: $ 50万
• 依托单位: IMPACT RESEARCH AND DEVELOPMENT ORG
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8513781
• 关键词: GH11; 005; Kenya; MALE; CIRCUMCISION

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.

标题：肯尼亚男性包皮环切预防艾滋病毒：寻求有效的战略， 招募老年人 背景：在肯尼亚，有140万至160万人感染艾滋病毒，成人患病率为 百分之六点三八个省之一的尼扬扎的流行率最高，为13.9%。在尼扬扎， 2005年12月20日至2006年12月30日， 省和全国第三-为20.2%（男性为17.1%，女性为22.8%）。几位司机 艾滋病毒在该省迅速传播的原因之一是缺乏 男性割礼大量的观察性研究和三项随机对照研究 试验结果一致，男性包皮环切术通过以下方式降低了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（MC）服务 截至2011年3月，在尼扬扎省为250 807人实施了割礼，其中115 196人 由我们的组织执行。然而，年龄较大的男子（25岁以上）接受服务的情况并不乐观， 感染艾滋病毒的风险更高的人一直难以捉摸。我们建议评估不同的战略， 招募年龄在25-39岁之间的男性-人际沟通（IPC），有条件的现金转移 (CCT)在尼扬扎，就MC的吸收和成本而言，IPC和CCT的组合。 目标和宗旨：为了实现80%的25-39岁男子接受割礼的目标， 目的是：i）评估25-39岁四类男性接受MC服务的比率 年：暴露于CCT的患者vs暴露于IPC的患者vs暴露于两种干预措施的患者 联合与那些没有接受干预; ii）确定提供MC的成本， 三次干预与无干预; iii）通过匿名检测血液， 切除包皮后，拒绝接受术前检测而感染艾滋病毒的男子所占比例; 和iv）将80%在MC环境中检测呈阳性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募方法：IPC，CCT和a 两者的结合。在IPC下，我们将雇用那些已经接受割礼的女性， 冠军，工作场所冠军，意见领袖进行一对一和小组 招募和转介到我们的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，并将提供HTC和MC教育， 有配偶的客户手术后，配偶/家庭成员将获得价值 肯尼亚先令每天1，750（23美元），为期一周。邮票将于 在养家糊口的人康复期间，交换食物供家庭使用; 结合IPC和CCT，两种干预措施一起实施的效果将是 检查;在控制区，将不实施干预。拟定研究 独特的几个方面：鉴于MC是一次性的干预，使用现金奖励，以增加 采用这些服务将在更快地对人口产生影响方面取得回报; 利用当地资源和现有社区结构促进公共卫生， 向配偶转移现金将促进妇女参与决策， 在他们配偶的割礼上做什么。我们预计，在一年内， 在过去两年半里，25-39岁的男子接受了割礼，人数从10 519人增加到21 038人， IPC、CCT和IPC/CCT干预的贡献比分别为1：1.5：2。