Increasing early infant male circumcision uptake in Zambia: Like Father, Like Son

抽象的。尽管令人信服的研究支持自愿医疗男性包皮环切术（VMMC）作为传达 虽然艾滋病毒终生感染风险降低60- 75%，但大多数赞比亚男子不愿意接受VMMC。的 赞比亚共和国政府以及其他几个撒哈拉以南国家， 婴儿男性包皮环切术（EIMC）作为整体计划的重要组成部分，以增加男性 在人口水平上进行包皮环切。然而，尽管该程序的假设可接受性似乎 在赞比亚孕妇中比例最高（97%），但试点研究表明，EIMC的使用率极低（11%）。 尽管人们普遍认为EIMC将传达短期和长期的健康状况， 由于这些优势，赞比亚父母对EIMC的吸收明显低于最初的目标， 赞比亚共和国政府“矛与盾1”（S&S1）综合成人艾滋病毒风险 该研究小组进行的减少计划显着增加了赞比亚男性的VMMC率 他们一开始并不想做这个手术目前，矛与盾2（S&S2） 传播和实施计划扩大了这个以社区卫生中心（CHC）为基础的 在赞比亚艾滋病毒感染率高、男性感染率低的四个省， 割礼到目前为止，约有20，000名男性和女性参加了S&S2计划。 这个R34应用程序“有其父必有其子”（LFLS）提议为 随机临床试验，以测试文化定制的EIMC干预，以显着增加摄取 男性割礼这种创新的战略，以提高接受和吸收EIMC和 VMMC将采用以家庭为导向的方法，以妊娠为重点，鼓励夫妇（n = 300 夫妇）考虑其男性新生儿的EIMC和所有合格家庭成员的VMMC。拟议 一项为期三年的可行性研究将建立在成功的S&S模型的基础上，并开发和试点测试关键干预措施 在社区卫生中心产前诊所接受产前检查的夫妇中， 艾滋病毒咨询和检测工作人员将接受培训，以进行S&S+LFLS。 本规划补助金申请建议：1）利用协作社区和专家的投入， 研究方案、LFLS组成部分的内容和评估工具; 2）整合LFLS对 3）评估干预对可接受性和吸收的影响， 评估在家庭内进行整合的可行性和可接受性 在赞比亚社区卫生中心的背景下进行干预。这项可行性研究将提供基础（议定书， 干预、评估工具）进行S&S+LFLS随机临床试验，以显着改善MC 赞比亚男子和他们的儿子之间的吸收。如果成功的话，S&S和LFLS的结合可能会有一个 对VMMC和EIMC的全国吸收具有协同效应。

Abstract. Despite compelling research supporting Voluntary Medical Male Circumcision (VMMC) as conveying life-time HIV risk reduction by 60-75%, most Zambian men have been reluctant to undergo VMMC. The Government of the Republic of Zambia, as well as several other Sub-Saharan countries, has identified Early Infant Male Circumcision (EIMC) as an important component of the overall program to increase male circumcision at the population level. However, though the hypothetical acceptability of the procedure appears high among pregnant Zambian women (97%), pilot studies indicate extremely low uptake of EIMC (11%). Although there is widespread agreement that EIMC would convey both short- and long-term health advantages, the uptake of EIMC by Zambian parents has been significantly lower than originally targeted by the Government of the Republic of Zambia. The “Spear and Shield 1” (S&S1) comprehensive adult HIV risk reduction program conducted by this research team significantly increased VMMC rates among Zambian men who initially had no interest in undergoing the procedure. Currently, the Spear and Shield 2 (S&S2) dissemination and implementation program has expanded this Community Health Center (CHC)-based program to 96 CHCs in four Zambian Provinces with high rates of HIV and low prevalence of male circumcision. To date, ~20,000 men and women have attended the S&S2 program. This R34 application, “Like Father, Like Son(s)” (LFLS), proposes to develop the foundation for a randomized clinical trial to test a culturally tailored EIMC intervention to significantly increase the uptake of male circumcision. This innovative strategy for increasing the acceptability and uptake of both EIMC and VMMC will utilize a family-oriented approach, using pregnancy as the pivot to encourage couples (n = 300 couples) to consider EIMC for their male neonates and VMMC for all eligible family members. The proposed three-year feasibility study will build on the successful S&S model and develop and pilot test key intervention components among couples attending antenatal clinics in CHCs; CHC health care providers will be trained to perform VMMC and EIMC, and HIV Counseling and Testing staff will be trained to conduct S&S+LFLS. This planning grant application proposes to 1) utilize collaborative community and expert input to develop the study protocol, content of the LFLS component, and assessment instruments; 2) integrate the LFLS couple sessions into the S&S program; 3) evaluate the influence of the intervention on acceptability and uptake of VMMC and EIMC within the family; and 4) evaluate the feasibility and acceptability of conducting the integrated intervention within the Zambian CHC context. This feasibility study would provide the foundation (protocol, intervention, assessment instruments) for a randomized clinical trial of S&S+LFLS to significantly improve MC uptake among Zambian men and their sons. If successful, the combination of S&S and LFLS could have a synergistic effect on the nation-wide uptake of VMMC and EIMC.