Multilevel determinants of male circumcision uptake, Rakai, Uganda

描述（由申请人提供）：K25指导职业发展奖的目标是促进候选人从生物统计学家到艾滋病毒预防科学家的职业转变，致力于在高危人群中促进艾滋病毒预防行为。我们现在有有效的生物医学干预措施来综合预防艾滋病毒（例如男性包皮环切术、治疗预防和预防前准备）。然而，这些战略对流行病的影响取决于行为，包括接受、遵守/保留和预防风险补偿。我的长期目标是进行独立的社会流行病学研究，以确定和解释影响艾滋病毒预防行为的个人和社会因素，开发统计方法来解决此类研究中遇到的分析挑战，并在设计，实施和评估干预措施方面提供领导，以促进寻求艾滋病毒预防行为的健康。通过K25的培训和指导将使我在行为艾滋病毒预防干预的理论和方法框架方面打下良好的基础。在约翰霍普金斯大学的指导专业知识和乌干达Rakai健康科学项目（RHSP）的研究基础设施的基础上，拟议的指导研究旨在确定和解释Rakai地区医疗男性包皮环切（MMC）接受情况的多层次预测因素。MMC是撒哈拉以南非洲一项重要的艾滋病毒预防战略，其对艾滋病毒流行的长期人口影响取决于男性接受的速度和覆盖率。RHSP通过Rakai社区队列研究（RCCS），对50个社区15-49岁的自愿居民进行年度艾滋病毒/性传播感染、健康和行为监测，并自2007年以来在Rakai区提供免费的MMC服务。然而，尽管广泛传播了关于MMC的健康益处和免费服务提供的信息，但RCCS社区的使用率仍然不理想（2013年非穆斯林男子的覆盖率为35%）。迫切需要研究MMC吸收的决定因素，以创造需求和提供有针对性的服务。利用RCCS数据，本研究将确定个体社会人口学、行为和心理社会因素对MMC接受度的预测；通过在RCCS 2015调查中增加一个新的调查模块，该研究将确定人际和社区层面的MMC摄取预测因素。此外，将对男性进行定性深入访谈和焦点小组讨论，以阐明某些男性接受或不接受MC的原因。定量证据，通过定性观察的增强，将作为R21/01制定有针对性的策略的基础，以增加MMC的吸收，增强MMC对人口水平的影响。结合候选人现有的定量技能，行为科学理论的培训和定性方法的介绍将帮助候选人建立一个独立的职业生涯，促进与广泛的艾滋病毒预防干预措施（例如MMC， ART， ART前艾滋病毒护理，PrEP和PMTCT）相关的健康行为。

DESCRIPTION (provided by applicant): The objective of this K25 Mentored Career Development Award is to facilitate the candidate's career transition from a biostatistician to an HIV prevention scientist dedicated to promoting HIV preventive behaviors in at-risk populations. We now have efficacious biomedical interventions for combined HIV prevention (e.g. male circumcision, treatment as prevention and PrEP). However, the impact of these strategies on the epidemic is contingent on behaviors including acceptance, adherence/retention and prevention of risk compensation. My long-term goal is to conduct independent social epidemiologic research to identify and interpret individual and societal factors influencing HIV preventive behaviors, to develop statistical methods to address the analytic challenges encountered in such research, and provide leadership in the design, implementation and evaluation of interventions to promote health seeking behaviors for HIV prevention. The training and mentorship through this K25 will allow me to become well grounded in the theoretical and methodological frameworks that underlie behavioral HIV preventive interventions. Building on the mentoring expertise at the Johns Hopkins University and the research infrastructure of the Rakai Health Sciences Program (RHSP) in Uganda, the proposed mentored research seeks to identify and interpret multilevel predictors for medical male circumcision (MMC) uptake in Rakai. MMC is an important HIV prevention strategy for sub-Saharan Africa (S-SA), and its long-term population impact on the HIV epidemic depends on the pace of uptake and level of coverage in men. RHSP conducts annual HIV/STI, health and behavioral surveillance in consenting residents aged 15-49 in 50 communities through the Rakai Community Cohort Study (RCCS),and since 2007 has provided free MMC services in Rakai District. However, despite wide dissemination of information on the health benefits of MMC and free service provision, uptake in RCCS communities remains suboptimal (35% coverage among non-Muslim men in 2013). Research on determinants of MMC uptake is urgently needed for demand creation and targeted service provision. Using RCCS data, this study will identify individual sociodemographic, behavioral and psychosocial predictors of MMC acceptance; and by adding a new survey module to the RCCS 2015 surveys, the study will identify interpersonal and community level predictors of MMC uptake. Additionally, qualitative in-depth interviews and focus group discussions with men will be conducted to elucidate reasons why certain men do or do not accept MC. The quantitative evidence, augmented by the qualitative observations, will serve as the basis for an R21/01 to develop targeted strategies to increase MMC uptake and enhance the population level impact of MMC. Combining with the candidate's existing quantitative skills, the training in behavioral science theories and introduction to qualitative methods will help the candidate to establish an independent career in promoting health behaviors associated with a broad range of HIV preventive interventions (e.g. MMC, ART, pre-ART HIV care, PrEP and PMTCT).