Multilevel determinants of male circumcision uptake, Rakai, Uganda

乌干达拉凯男性包皮环切率的多层次决定因素

• 批准号: 9067920
• 负责人: Xiangrong Kong
• 金额: $ 8.19万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9067920
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; Africa South of the Sahara; Attitude; Behavior; Behavior Therapy; Behavioral; Behavioral Research; Behavioral Sciences; Career Mobility; Caring; Characteristics; Cohort Studies; Communities; Complement; Consent; Counseling; Data; Data Analyses; Data Collection; Diffusion; Epidemic; Epidemiologic Studies; Evaluation; Event; Financial compensation; Focus Groups; Funding; Future; General Population; Goals; HIV; HIV/STD; Health Benefit; Health Sciences; Health behavior; Incidence; Individual; Information Dissemination; Intervention; Interview; K-Series Research Career Programs; Leadership; Male Circumcision; Medical; Mentors; Mentorship; Methods; Modeling; Monitor; Outcome; Play; Policies; Population; Populations at Risk; Prevention; Prevention strategy; Preventive; Preventive Intervention; Procedures; Process; Prophylactic treatment; Psychosocial Factor; Qualitative Methods; Research; Research Infrastructure; Research Methodology; Research Personnel; Risk; Role; Scientist; Services; Societal Factors; Statistical Methods; Supervision; Surveys; Targeted Research; Testing; Time; Training; Translating; Uganda; Universities; Vertical Disease Transmission; aged; base; behavioral health; career; condoms; contextual factors; cost effective; cost efficient; design; experience; health seeking behavior; men; peer; population based; prevent; programs; psychosocial; public health relevance; randomized trial; scale up; sex risk; skills; skills training; social; social learning; surveillance data; theories; uptake

DESCRIPTION (provided by applicant): The objective of this K25 Mentored Career Development Award is to facilitate the candidate's career transition from a biostatistician to an HIV prevention scientist dedicated to promoting HIV preventive behaviors in at-risk populations. We now have efficacious biomedical interventions for combined HIV prevention (e.g. male circumcision, treatment as prevention and PrEP). However, the impact of these strategies on the epidemic is contingent on behaviors including acceptance, adherence/retention and prevention of risk compensation. My long-term goal is to conduct independent social epidemiologic research to identify and interpret individual and societal factors influencing HIV preventive behaviors, to develop statistical methods to address the analytic challenges encountered in such research, and provide leadership in the design, implementation and evaluation of interventions to promote health seeking behaviors for HIV prevention. The training and mentorship through this K25 will allow me to become well grounded in the theoretical and methodological frameworks that underlie behavioral HIV preventive interventions. Building on the mentoring expertise at the Johns Hopkins University and the research infrastructure of the Rakai Health Sciences Program (RHSP) in Uganda, the proposed mentored research seeks to identify and interpret multilevel predictors for medical male circumcision (MMC) uptake in Rakai. MMC is an important HIV prevention strategy for sub-Saharan Africa (S-SA), and its long-term population impact on the HIV epidemic depends on the pace of uptake and level of coverage in men. RHSP conducts annual HIV/STI, health and behavioral surveillance in consenting residents aged 15-49 in 50 communities through the Rakai Community Cohort Study (RCCS),and since 2007 has provided free MMC services in Rakai District. However, despite wide dissemination of information on the health benefits of MMC and free service provision, uptake in RCCS communities remains suboptimal (35% coverage among non-Muslim men in 2013). Research on determinants of MMC uptake is urgently needed for demand creation and targeted service provision. Using RCCS data, this study will identify individual sociodemographic, behavioral and psychosocial predictors of MMC acceptance; and by adding a new survey module to the RCCS 2015 surveys, the study will identify interpersonal and community level predictors of MMC uptake. Additionally, qualitative in-depth interviews and focus group discussions with men will be conducted to elucidate reasons why certain men do or do not accept MC. The quantitative evidence, augmented by the qualitative observations, will serve as the basis for an R21/01 to develop targeted strategies to increase MMC uptake and enhance the population level impact of MMC. Combining with the candidate's existing quantitative skills, the training in behavioral science theories and introduction to qualitative methods will help the candidate to establish an independent career in promoting health behaviors associated with a broad range of HIV preventive interventions (e.g. MMC, ART, pre-ART HIV care, PrEP and PMTCT).

描述（由申请人提供）：K25 指导职业发展奖的目的是促进候选人从生物统计学家到艾滋病毒预防科学家的职业转型，致力于促进高危人群的艾滋病毒预防行为。我们现在拥有有效的生物医学干预措施来联合预防艾滋病毒（例如男性包皮环切术、治疗即预防和 PrEP）。然而，这些策略对疫情的影响取决于风险补偿的接受、坚持/保留和预防等行为。我的长期目标是进行独立的社会流行病学研究，以确定和解释影响艾滋病毒预防行为的个人和社会因素，开发统计方法来解决此类研究中遇到的分析挑战，并在设计、实施和评估方面发挥领导作用。促进寻求健康行为以预防艾滋病毒的干预措施。通过 K25 的培训和指导将使我在艾滋病毒行为预防干预措施的理论和方法框架上打下坚实的基础。拟议的指导研究以约翰·霍普金斯大学的指导专业知识和乌干达拉凯健康科学计划 (RHSP) 的研究基础设施为基础，旨在识别和解释拉凯医疗男性包皮环切术 (MMC) 采用的多级预测因素。 MMC 是撒哈拉以南非洲 (S-SA) 的重要艾滋病毒预防战略，其对艾滋病毒流行的长期人口影响取决于男性的接受速度和覆盖水平。 RHSP 通过 Rakai 社区队列研究 (RCCS) 对 50 个社区中 15-49 岁的同意居民进行年度 HIV/STI、健康和行为监测，并自 2007 年以来在 Rakai 区提供免费 MMC 服务。然而，尽管广泛传播了关于 MMC 健康益处和免费服务提供的信息，RCCS 社区的采用率仍然不理想（2013 年非穆斯林男性的覆盖率为 35%）。为了创造需求和提供有针对性的服务，迫切需要研究 MMC 吸收的决定因素。利用 RCCS 数据，本研究将确定 MMC 接受度的个体社会人口、行为和社会心理预测因素；通过在 RCCS 2015 调查中添加新的调查模块，该研究将确定 MMC 吸收的人际和社区层面的预测因素。此外，还将与男性进行定性深入访谈和焦点小组讨论，以阐明某些男性接受或不接受 MC 的原因。定量证据加上定性观察，将作为 R21/01 制定有针对性的战略的基础，以增加 MMC 的吸收并增强 MMC 对人口水平的影响。结合候选人现有的定量技能，行为科学理论的培训和定性方法的介绍将帮助候选人建立独立的职业生涯，促进与广泛的艾滋病毒预防干预措施（例如 MMC、ART、pre-ART HIV 护理、PrEP 和 PMTCT）。