Tracking Risk Compensation Over Time in a National MC Roll-Out in Zimbabwe

跟踪津巴布韦国家 MC 推广中随时间推移的风险补偿

• 批准号: 8877311
• 负责人: DANIEL E MONTANO
• 金额: $ 44.93万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8877311
• 关键词: AIDS prevention; AIDS/HIV problem; Adult; Age; Behavior; Behavioral; Behavioral Model; Belief; Child Welfare; Cities; Clinic; Cohort Studies; Communication; Counseling; Country; Data; Documentation; Epidemic; Farming environment; Financial compensation; Goals; HIV; Healed; Health; Human immunodeficiency virus test; Individual; Kenya; Lead; Longitudinal Studies; Male Circumcision; Measures; Modeling; Oranges; Pattern; Policy Maker; Population; Prevalence; Prevention; Prevention program; Prevention strategy; Primary Health Care; Provider; Randomized Controlled Trials; Recommendation; Recruitment Activity; Research Personnel; Risk; Risk Behaviors; Safe Sex; Scientist; Sex Behavior; Sexually Transmitted Diseases; South Africa; Surveys; Testing; Time; Uganda; Visit; World Health Organization; Zimbabwe; base; cohort; comparison group; condoms; design; evidence base; follow-up; healing; male; men; men who have sex with men; prevent; programs; prospective; psychosocial; satisfaction; theories; uptake; young adult

DESCRIPTION (provided by applicant): Male circumcision (MC) is currently one of the most effective biomedical HIV-prevention strategies that can be implemented in high HIV prevalence countries (Auvert, et al, 2005; Gray, et al., 2007; Bailey, et al., 2007). Modeling shows that high uptake of MC must occur in a young adult male population to have the largest impact on the HIV/AIDS epidemic, but this may be offset by risk compensation (RC) (Bollinger et al., 2009; Gray, et al., 2007; UNAIDS, 2009); that is, men who are circumcised may compensate for the protection MC offers by increasing their risk behavior (Templeton, 2010). Follow-up with the three MC randomized control trial (RCT) cohorts in Kenya, Uganda, and South Africa suggests little RC over time. However, the men in these RCTs were followed intensely (every 3 or 6 months) with prevention counseling, STD treatment, and free condoms offered at each follow-up visit. Thus, the RCT cohorts are unlikely to provide a good indication of the degree to which RC will occur in an ordinary roll out of MC where repeat intensive prevention counseling is not feasible. There is a clear need to determine whether risk compensation occurs among men getting circumcised through national MC programs that are being implemented in high HIV-prevalence countries, and to develop strategies to prevent it. Since Zimbabwe is currently implementing an MC program as part of its national HIV prevention strategy, this is the ideal time and setting to conduct a longitudinal study to determine: a) whether RC occurs among men circumcised through this program, b) the prevalence and change in prevalence in RC over time since circumcision, and c) the behavioral determinants of RC. Thus, we propose to conduct a cohort study where we will accrue 1200 randomly selected men from those who have made a decision to get circumcised and a non-equivalent comparison group of 1200 men who have decided not to get circumcised. We will conduct surveys of these men at baseline (prior to circumcision) and at 6-, 12-, 24-, and 36-months, in order to determine whether RC occurs soon after MC healing or whether RC continues longer term. The Integrated Behavioral Model (Montano & Kasprzyk, 2008) will provide the theoretical framework for designing the survey to measure potential environmental (socio-cultural) and individual (attitudinal, normative, personal agency, sexual satisfaction) determinants of RC behavior. Analyses will be carried out to determine whether there is differential change in risk behavior among men who get circumcised compared with those who do not, and the patterns of change in RC over time; and to identify specific model constructs and beliefs that best explain RC. These results will then govern theory-based prevention messages. The study will include men in Zimbabwe's two main cities, Harare and Bulawayo, which will allow us to determine whether there are ethnic (Shona, Matabele) differences in RC and determinants. This study will be the first to provide information on the prevalence of risk compensation in a national program rolling out circumcision, as well as model the determinants of this behavior in order to design effective risk-prevention messages.

描述（由申请人提供）：男性包皮环切术（MC）目前是可以在HIV高流行率国家实施的最有效的生物医学HIV预防策略之一（Auvert等人，2005; Gray等人，2007; Bailey等人，2007年）。建模显示，MC的高摄取必须发生在年轻成年男性群体中，以对HIV/AIDS流行具有最大的影响，但这可能被风险补偿（RC）抵消（Bollinger等人，2009; Gray等人，2007年;联合国艾滋病规划署，2009年）;也就是说，男性谁是包皮环切术可能会增加他们的风险行为补偿MC提供的保护（邓普顿，2010年）。在肯尼亚、乌干达和南非进行的三项MC随机对照试验（RCT）队列的随访表明，随着时间的推移，RC很少。然而，这些随机对照试验中的男性被密切随访（每3或6个月），每次随访时提供预防咨询，性病治疗和免费避孕套。因此，随机对照试验队列不太可能提供一个很好的程度，RC将发生在一个普通的推出MC重复密集的预防咨询是不可行的。有一个明确的需要，以确定是否风险补偿发生在男性之间得到割礼通过国家MC计划正在实施的艾滋病毒高流行率国家，并制定战略，以防止它。由于津巴布韦目前正在实施MC计划作为其国家艾滋病毒预防战略的一部分，这是理想的时间和设置进行纵向研究，以确定：a）通过该计划接受包皮环切术的男性中是否发生RC，B）自包皮环切术以来RC的患病率和患病率随时间的变化，以及c）RC的行为决定因素。因此，我们建议进行一项队列研究，我们将从决定接受包皮环切术的男性中随机选择1200名男性，并将1200名决定不接受包皮环切术的男性作为非等效对照组。我们将在基线（包皮环切术前）和6个月、12个月、24个月和36个月时对这些男性进行调查，以确定RC是否在MC愈合后不久发生或RC是否持续更长时间。综合行为模型（Montano & Kasprzyk，2008）将为设计调查提供理论框架，以衡量RC行为的潜在环境（社会文化）和个人（态度，规范，个人代理，性满意度）决定因素。将进行分析，以确定是否有差异的风险行为之间的男性谁得到包皮环切术与那些谁不相比，和RC随时间的变化模式;并确定具体的模型结构和信念，最好地解释RC。这些结果将指导基于理论的预防信息。这项研究将包括津巴布韦两个主要城市，哈拉雷和布拉瓦约的男子，这将使我们能够确定在RC和决定因素方面是否存在种族（Shona、Matabele）差异。这项研究将是第一个提供信息的风险补偿在一个国家计划推出包皮环切术的流行，以及模型的决定因素，这种行为，以设计有效的风险预防信息。