Integration of infant male circumcision with community health services in Kenya

肯尼亚将婴儿男性包皮环切术与社区卫生服务相结合

• 批准号: 8884254
• 负责人: Robert Converse Bailey
• 金额: $ 46.59万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8884254
• 关键词: 15 year old; AIDS prevention; Adolescent; Adult; Africa South of the Sahara; African; Area; Belief; Centers for Disease Control and Prevention (U.S.); Child health care; Client; Clinical; Communities; Community Health; Community Health Services; Country; Cross-Sectional Studies; Decision Making; Disinhibition; Education; Ensure; Epidemic; Fathers; Female; Financial compensation; Funding; Government; Government Programs; Guidelines; HIV; Health; Health Personnel; Health Services Accessibility; Health care facility; Health education; Infant; Intervention; Interview; Kenya; Knowledge; Location; Male Circumcision; Maternal and Child Health; Methods; Modeling; Mothers; Neonatal; Observational Study; Oral; Outcome; Parents; Phase; Pilot Projects; Poliomyelitis; Positioning Attribute; Prevention; Prevention program; Prevention strategy; Process; Provider; Province; Randomized Controlled Trials; Relative (related person); Reproductive Health; Research; Resource Allocation; Risk; Safety; Sampling; Science; Services; Signal Transduction; Societies; Son; Source; Southern Africa; Structure; Target Populations; Testing; Training; Translating; Vaccination; Vaccines; World Health Organization; base; cost; cost effectiveness; evidence base; experience; high risk; innovation; male; men; perinatal health; programs; prospective; satisfaction; scale up; sound; success; transmission process; uptake

DESCRIPTION (provided by applicant): Adult male circumcision (AMC) decreases female to male transmission of HIV by approximately 60%. The WHO recommends MC be offered as one component of an HIV prevention strategy in high risk areas and that neonatal MC be considered for long-term, sustainable HIV prevention. Infant male circumcision (IMC) confers the same benefits of AMC for HIV and STI prevention, and is less expensive and safer. Results of recent cost- effectiveness analyses find IMC is cost-saving for long-term HIV prevention under conditions that prevail in many African nations and elsewhere. Despite the compelling advantages of IMC relative to AMC, little research has been conducted to guide scale-up of services. We recently conducted a successful pilot study of safety and factors associated with acceptance or refusal of IMC in Nyanza, Kenya. We have trained 17 IMC providers and have performed over 1,000 IMCs. We have the technical, scientific and clinical capacity to conduct high-quality research on IMC. Nyanza, Kenya is the ideal location to conduct this research because the success of the adult male circumcision program (ahead of every other country where MC has been implemented) indicates Kenya is ready to transition toward IMC. To provide the evidence-base necessary to guide implementation of IMC services, we propose a simultaneous, prospective comparison of two sustainable, scalable models of IMC service delivery (Aim 1). The models include a standard service delivery package (SDP) and a standard package plus (SDPplus). The SDP model integrates IMC education and recruitment into existing community-based perinatal health education networks and includes provision of comprehensive IMC services at health facilities. The SDPplus model will implement the standard package and add community- delivered IMC services. The two models will be compared in terms of uptake, parental acceptability, cost and safety. In addition, we will conduct a cross-sectional survey administered to 3,750 mothers and fathers of young male infants to assess barriers and facilitators to IMC prior to implementation (n=750) of IMC services, and after implementation (n=3000) of the intervention (Aim 2). We will examine the impact of our interventions on knowledge of IMC and barriers to uptake, identify factors associated with IMC uptake, and determine how this varies between SDP and SDPplus. Governments in East and southern Africa and PEPFAR have signaled a transition towards lMC for long-term, sustainable HIV prevention programming. At the conclusion of this study, we will have determined the relative advantages of two models of IMC service delivery that are scalable and can be integrated into existing MCH care structures under conditions that prevail in many African nations. These findings will provide the evidence necessary to assist the Kenyan MoH, PEPFAR and other African governments as to the rational, evidenced-based allocation of resources in the scale-up of IMC service delivery for long-term HIV prevention.

描述（由申请人提供）：成年男性包皮环切术（AMC）使女性向男性的HIV传播减少约60％。 WHO建议将MC作为高风险领域的HIV预防策略的一部分，并考虑新生儿MC以长期可持续的HIV预防。婴儿男性包皮环切术（IMC）赋予了AMC对艾滋病毒和性传播感染预防的相同好处，并且更便宜，更安全。最近的成本效益分析的结果发现，在许多非洲国家和其他地方盛行的条件下，IMC对预防长期艾滋病毒的成本促进了成本。尽管IMC相对于AMC具有令人信服的优势，但很少进行研究以指导服务规模。我们最近对肯尼亚Nyanza接受或拒绝IMC的安全性和因素进行了成功的试点研究。我们已经培训了17个IMC提供商，并执行了1000多个IMC。我们具有对IMC进行高质量研究的技术，科学和临床能力。肯尼亚Nyanza是进行这项研究的理想场所，因为成年男性包皮环切术计划的成功（在其他MC的其他国家 /地区之前）表示肯尼亚已准备好向IMC过渡。为了提供指导IMC服务实施必要的证据基础，我们提出了对IMC服务交付的两个可持续可伸缩模型的同时，预期的比较（AI​​M 1）。这些型号包括标准服务交付软件包（SDP）和标准软件包加上（SDPPLUS）。 SDP模型将IMC的教育和招聘集成到现有的基于社区的围产期健康教育网络中，并包括在医疗机构提供全面的IMC服务。 SDPPLUS模型将实施标准软件包，并添加社区交付的IMC服务。这两种模型将根据摄取，父母的可接受性，成本和安全性进行比较。此外，我们将对3,750名年轻男性婴儿的母亲和父亲进行横断面调查，以评估IMC服务实施（n = 750）的障碍和促进因子，并在实施后（n = 3000）（n = 3000）（aim 2）。我们将研究干预措施对IMC知识和吸收障碍，确定与IMC摄取相关的因素的影响，并确定SDP和SDPPLUS之间的变化。东非和南部的政府和佩帕尔（Pepfar）的政府表明，向LMC过渡了长期，可持续的艾滋病毒预防计划。在这项研究的结论中，我们将确定两种可扩展的IMC服务交付模型的相对优势，可以在许多非洲国家盛行的条件下整合到现有的MCH护理结构中。这些发现将提供必要的证据，以协助肯尼亚MOH，PEPFAR和其他非洲政府，表明在IMC服务提供长期预防HIV的IMC服务提供中，基于合理的，有证据的资源分配。

项目成果

What device would be best for early infant male circumcision in east and southern Africa? Provider experiences and opinions with three different devices in Kenya.

• DOI: 10.1371/journal.pone.0171445
• 发表时间: 2017
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Bailey RC;Nyaboke I;Otieno FO
• 通讯作者: Otieno FO

Factors Associated with Preference for Early Infant Male Circumcision Among a Representative Sample of Parents in Homa Bay County, Western Kenya.

肯尼亚西部霍马湾县代表性父母样本中与早期婴儿男性包皮环切偏好相关的因素。

• DOI: 10.1007/s10461-016-1288-y
• 发表时间: 2016
• 期刊: AIDS and behavior
• 影响因子: 4.4
• 作者: Young,MarisaR;Adera,Frederick;Mehta,SupriyaD;Jaoko,Walter;Adipo,Timothy;Badia,Jacinta;Nordstrom,SherryK;Irwin,TracyE;Ongong'a,Dedan;Bailey,RobertC
• 通讯作者: Bailey,RobertC