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

摘要 印度尼西亚的艾滋病毒携带者人数继续攀升，特别是在塔纳省 巴布亚基于节欲或更安全的性行为的预防努力只显示出一定的成功，并准备 未经政府批准使用。自愿医疗男性包皮环切术(VMMC)作为一次性程序 已经通过临床试验表明，通过以下方式降低男性异性获得艾滋病毒感染的风险 大约60%。目前，Tanah巴布亚不提供VMMC，与印度尼西亚其他地区不同， 绝大多数男人没有受过割礼。这项研究将开发、实施和评估可行性， VMMC巴布亚土著模式(PIM)作为一种综合的、文化的和 针对巴布亚12-18岁男性的适龄艾滋病毒干预。包皮环切术提供部分终生艾滋病毒 保护和宝贵的机会，让青春期男性参与卫生保健系统，同时灌输 艾滋病毒预防行为。这项研究的4个目标：目标1：让巴布亚社区成员参与探索 引入以学校为基础的年龄和文化上适当的可接受性、障碍和促进者， 综合VMMC干预措施，以降低巴布亚人群中的艾滋病毒发病率。目标2：评估 社区卫生系统达到国际安全、全面的VMMC服务标准的能力 并确保在选定的诊所提供所需的资源和培训，以达到这些标准。目标 3：根据《目标1》、《目标2》和《目标2》中收集的信息，设计以校本为基础的青少年心理健康教育模式 与社区咨询委员会、卫生部和教育部进行协商。目标4：实现 VMMC以学校为基础的PIM干预试点--对400名12-18岁有两个HIV高危人群的男孩进行干预 巴布亚地区：纳比勒和查亚普拉。将通过焦点小组、深入访谈等方式收集数据 与主要社区利益攸关方和青少年一起，向青春期男性发放简短的问卷 术后6周，随机抽样30名男孩，在摘除装置后12周接受采访，以 检测满意度的变化、性行为的开始，以及可能的补偿性风险。 家长访谈将评估他们的满意度。主要结果是青春期男性的比例 接受以学校为基础的PIM VMMC教育和信息会议，接受割礼和手术 赛事安全。次要结果是青春期男性和父母的满意度， 包皮环切术后6周，基线和12周后性行为危险行为的变化 包皮环切术，以及提供商对MC培训和实施、设备使用便利性的看法，以及 遇到了挑战。这项研究的影响在于开发了一种经过严格的试点测试的 在巴布亚，为12-18岁的青少年男子提供适合文化和年龄定制的VMMC服务模式， 在那里，其他艾滋病毒预防服务很难实施，而且这种流行病被证明是难以解决的。

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.