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.

摘要 印度尼西亚艾滋病毒感染者人数继续攀升，特别是在塔纳省 在巴布亚，基于禁欲或安全性行为的预防工作只取得了有限的成功， 政府没有批准使用。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，通过以下方式降低男性通过异性性行为感染艾滋病毒的风险： 大约60%。目前，塔纳巴布亚不提供VMMC，与印度尼西亚其他地区不同，这里 绝大多数男人都没有割包皮。这项研究将开发，实施和评估的可行性， 可接受性和安全性的巴布亚土著模式（PIM）VMMC作为一个全面的，文化和 为12-18岁的巴布亚男性提供适合年龄的艾滋病毒干预。包皮环切术提供部分寿命的艾滋病毒 保护和宝贵的机会，使青少年男性与卫生保健系统，同时灌输 艾滋病预防行为。该研究的4个目标：目标1：让巴布亚社区成员参与探索 采用学龄和文化上适当的入学年龄的可接受性、障碍和促进因素， 全面的VMMC干预措施，以降低巴布亚人口中的艾滋病毒发病率。目标2：评估 社区卫生系统达到国际标准的能力，以提供安全、全面的VMMC服务 并确保选定的诊所具备所需的资源和培训，以符合这些标准。目的 3：根据目标1和2以及 与社区咨询委员会、卫生部和教育部协商。目标4： 对400名年龄在12-18岁的两个艾滋病毒高危地区的男孩进行了VMMC的学校PIM干预的试点测试。 巴布亚地点：纳比雷和贾亚普拉。数据将通过焦点小组、深入访谈 与主要的社区利益攸关方和青少年一起，向青少年男性发放了简短的问卷， 术后6周，随机抽取30名男孩，在器械取出后12周接受采访， 检测满意度水平的变化，性活动的开始，以及可能的补偿性风险。 家长访谈将评估他们的满意度。主要结果是青少年男性的比例 接受包皮环切术和手术的学生参加以学校为基础的PIM VMMC教育和信息会议 事件安全。次要结果是青少年男性和父母的满意度， 包皮环切术后6周，基线和术后12周之间的性风险行为变化 包皮环切术，以及提供者对MC培训和实施的看法，器械使用的便利性，以及 遇到的挑战。这项研究的影响在于开发了一种 为巴布亚12-18岁的男性青少年提供适合文化和适合年龄的VMMC服务模式， 在这些地区，其他艾滋病毒预防服务难以实施，而且这种流行病也难以控制。