The Papuan Indigenous Model of Voluntary Medical Male Circumcision (VMMC)

巴布亚原住民自愿医疗男性包皮环切术 (VMMC) 模式

• 批准号: 10256068
• 负责人: Robert Converse Bailey
• 金额: $ 18.4万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-07 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10256068
• 关键词: AIDS prevention; Abstinence; Adolescent; Adopted; Adult; Affect; Age; Attention; Bacterial Vaginosis; Behavior; Cities; Clinic; Clinical Trials; Communities; Community Health Systems; Consultations; Counseling; Country; Data; Device Removal; Devices; Education; Elderly; Ensure; Epidemic; Ethnic group; Event; Excision; Exposure to; Female; Focus Groups; General Population; Genital; Genitalia; Government; Government Programs; HIV; HIV Infections; Health; Healthcare Systems; Heterosexuals; Human Papillomavirus; Incidence; Indigenous; Indonesia; Infection; Injecting drug user; International; Intervention; Interview; Island; Life; Location; Male Adolescents; Male Circumcision; Medical; Modeling; Muslim population group; Operative Surgical Procedures; Outcome Study; Parents; Perception; Policies; Population; Prevalence; Prevention; Prevention strategy; Preventive; Procedures; Provider; Province; Questionnaires; Recommendation; Religious Belief; Research; Resources; Rest; Risk; Safe Sex; Safety; Schools; Services; Sex Behavior; Sexual Health; Sexual Partners; Testing; Time; Training; Ulcer; Voluntary Programs; Youth; acceptability and feasibility; base; boys; cost effectiveness; design; experience; high risk; implementation study; male; member; men; men who have sex with men; penis foreskin; prevention service; primary outcome; programs; response; satisfaction; secondary outcome; sexual HIV transmission; sexual risk behavior; sexual risk taking; success; transmission process; uptake

ABSTRACT The number of people living with HIV continues to climb in Indonesia, especially in the province of Tanah Papua where prevention efforts based on abstinence or safer sex have shown only modest success, and PreP is not government approved for use. Voluntary medical male circumcision (VMMC) as a one-time procedure has been shown through clinical trials to reduce the risk of heterosexually acquired HIV infection in men by approximately 60%. Currently VMMC is not offered in Tanah Papua, where unlike the rest of Indonesia, the great majority of men are uncircumcised. This research will develop, implement, and assess the feasibility, acceptability, and safety of the Papuan Indigenous Model (PIM) of VMMC as a comprehensive, culturally and age-appropriate HIV intervention for Papuan males ages 12-18. Circumcision offers partial life-time HIV protection and a valuable opportunity to engage adolescent males with the health care system while instilling HIV preventive behaviors. The study’s 4 aims: AIM 1: To engage Papuan community members to explore acceptability, barriers and facilitators for introducing a school-based age and culturally appropriate, comprehensive VMMC intervention to reduce HIV incidence in the Papuan population. AIM 2: To assess the capacity of the community health system to meet international criteria for safe comprehensive VMMC services and to ensure the availability of resources and training necessary to meet these criteria in selected clinics. AIM 3: To design the PIM of school-based adolescent VMMC based on information collected in Aims 1 and 2 and in consultation with a community advisory board, the Ministry of Health and the Ministry of Education. AIM 4: To pilot-test the school-based PIM Intervention of VMMC with 400 boys ages 12-18 years at two HIV high-risk Papuan locations: the Nabire and Jayapura. Data will be collected through focus groups, in-depth interviews with key community stakeholders and adolescents, brief questionnaires administered to adolescent males pre- and 6 weeks post-surgery, a random subsampling of 30 boys interviewed 12 weeks post device-removal to detect changes in levels of satisfaction, onset of sexual activity, and possible compensatory sexual risk taking. Parent interviews will gauge their satisfaction. Primary outcomes are the proportion of adolescent males exposed to school-based PIM VMMC educational and informational sessions who get circumcised and surgical event safety. Secondary outcomes are satisfaction by adolescent males and parents, any sexual activity within 6 weeks after circumcision, changes in sexual risk behaviors between base-line and 12 weeks after circumcision, and perceptions of providers regarding MC training and implementation, ease of device use, and challenges encountered. The impact of the research lies in having developed and rigorously pilot-tested a culturally-appropriate, and age-tailored model of VMMC services for adolescent males ages 12-18 in Papua, where other HIV prevention services have been difficult to implement and the epidemic is proving intractable.

抽象的 印度尼西亚艾滋病毒感染者人数持续攀升，特别是在塔纳省 巴布亚，基于禁欲或安全性行为的预防工作仅取得了一定的成功，而 PreP 未经政府批准使用。自愿医疗男性包皮环切术 (VMMC) 作为一次性手术 临床试验表明，通过以下方式可降低男性异性感染艾滋病毒的风险： 大约60%。目前，丹那巴布亚不提供 VMMC，与印度尼西亚其他地区不同，该地区 绝大多数男性未受割礼。这项研究将开发、实施和评估可行性， VMMC 的巴布亚土著模式 (PIM) 作为一个综合性、文化性和安全性的可接受性和安全性 对 12-18 岁巴布亚男性进行适合年龄的艾滋病毒干预。包皮环切术可导致部分终身感染艾滋病毒 保护和让青春期男性参与医疗保健系统的宝贵机会，同时向他们灌输 艾滋病毒预防行为。该研究的 4 个目标： 目标 1：让巴布亚社区成员参与探索 引入学龄和文化适宜性的可接受性、障碍和促进因素， 全面的 VMMC 干预措施，以减少巴布亚人口的艾滋病毒发病率。目标 2：评估 社区卫生系统满足安全综合 VMMC 服务国际标准的能力 并确保选定诊所能够获得满足这些标准所需的资源和培训。目的 3：根据目标 1 和 2 以及目标 2 中收集的信息设计校本青少年 VMMC 的 PIM 与社区咨询委员会、卫生部和教育部协商。目标 4： 对 400 名 12 至 18 岁男孩进行 VMMC 校本 PIM 干预试点测试，两名艾滋病毒高危人群 巴布亚地点：纳比雷和查亚普拉。将通过焦点小组、深度访谈收集数据 与主要社区利益相关者和青少年一起，在 手术后 6 周，在装置移除后 12 周对 30 名男孩进行了随机抽样调查， 检测满意度水平的变化、性活动的开始以及可能的补偿性性冒险。 家长访谈将衡量他们的满意度。主要结果是青春期男性的比例 接受包皮环切术和手术的人参加基于学校的 PIM VMMC 教育和信息会议 活动安全。次要结果是青少年男性和父母的满意度、任何性活动 包皮环切术后 6 周，基线与术后 12 周之间性危险行为的变化 包皮环切术以及提供者对 MC 培训和实施、设备使用便利性的看法，以及 遇到的挑战。该研究的影响在于开发并经过严格的试点测试 为巴布亚 12-18 岁的男性青少年提供适合文化和年龄的 VMMC 服务模式， 其他艾滋病毒预防服务难以实施，而且该流行病也很棘手。