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

抽象的。尽管有令人信服的研究支持自愿医疗男性包皮环切术(VMMC) 终身艾滋病毒风险降低60%-75%，大多数赞比亚男性一直不愿接受VMMC。这个 赞比亚共和国政府以及其他几个撒哈拉以南国家很早就确定了 婴儿男性包皮环切术(EIMC)作为增加男性整体计划的重要组成部分 人口层面的包皮环切术。然而，尽管程序的假设性可接受性似乎 在赞比亚怀孕妇女中的比例很高(97%)，初步研究表明EIMC的摄取率极低(11%)。 尽管人们普遍认为，EIMC将同时传递短期和长期的健康 优势，赞比亚父母对EIMC的接受率明显低于最初的目标 赞比亚共和国政府。《长矛与盾牌1》(S和S1)成人艾滋病综合风险 该研究小组实施的减量计划显著增加了赞比亚男性中VMMC的发病率 他最初对接受这一手术没有兴趣。目前，《长矛与盾牌2》(S与S2) 传播和实施计划扩大了以社区卫生中心(CHC)为基础的 向艾滋病毒感染率高、男性感染率低的赞比亚四个省的96家社区卫生保健机构提供方案 割包皮。到目前为止，已有约20,000名男性和女性参加了S和S2项目。 这个R34应用程序“喜欢父亲，喜欢儿子(S)”(LFL)，建议为 随机临床试验，测试一种针对文化定制的EIMC干预措施，以显著增加对 男性包皮环切术。这一创新战略旨在提高EIMC和 VMMC将采用以家庭为导向的方法，以怀孕为支点鼓励夫妇(n=300 夫妻)为其男婴考虑EIMC，为所有符合条件的家庭成员考虑VMMC。建议数 为期三年的可行性研究将在成功的S和S模式的基础上，开发和试点重点干预措施 在妇幼保健中心产前诊所就诊的夫妇中的组成部分；将培训社区卫生保健提供者 执行VMMC和EIMC，并对艾滋病咨询和检测人员进行培训，以进行S和S+LFL。 此规划拨款申请建议1)利用协作社区和专家的意见来开发 LFLS的研究方案、内容和评估工具；2)整合LFLS夫妇 S和S计划中的对话；3)评估干预对接受和接受 家庭内部的VMMC和EIMC；以及4)评估进行集成的可行性和可接受性 在赞比亚禁毒会的背景下进行干预。这项可行性研究将提供基础(协议， 干预、评估工具)用于S和S+LFL显著改善MC的随机临床试验 在赞比亚男人和他们的儿子中被接受。如果成功，S和S与LFL的结合可能会有 在全国范围内采用VMMC和EIMC的协同效应。

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.