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）：这一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预防艾滋病毒的科学家的职业过渡，致力于促进高危人群中的艾滋病毒预防行为。现在，我们有有效的生物医学干预措施可用于预防HIV（例如，男性包皮环切术，作为预防治疗和PREP）。但是，这些策略对流行病的影响取决于行为，包括接受，依从性/保留和预防风险补偿。我的长期目标是进行独立的社会流行病学研究，以识别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，以应对此类研究中遇到的分析挑战，并在设计，实施和评估中提供领导力，以促进预防艾滋病毒预防艾滋病毒的健康行为。通过此K25的培训和指导将使我能够在行为艾滋病毒预防干预措施的理论和方法论框架中得到充分的依据。在约翰·霍普金斯大学的指导专业知识和乌干达Rakai Health Sciences计划（RHSP）的研究基础设施的基础上，拟议的指导研究旨在识别和解释Rakai医学男性包皮环切术（MMC）的多级预测指标。 MMC是撒哈拉以南非洲（S-SA）的重要预防艾滋病毒预防策略，其长期人口对艾滋病毒流行的影响取决于男性摄取和覆盖水平的速度。 RHSP通过Rakai社区队列研究（RCCS）在50个社区的同意居民中进行年度艾滋病毒/STI，健康和行为监测，自2007年以来，在Rakai地区提供了免费的MMC服务。然而，尽管大量传播了有关MMC和免费服务提供健康益处的信息，但RCCS社区的吸收仍然不错（2013年非穆斯林男性的覆盖率为35％）。迫切需要对MMC吸收决定因素进行研究，以创建需求和有针对性的服务提供。使用RCCS数据，本研究将确定MMC接受的个体社会人口统计学，行为和心理社会预测因素；通过在RCCS 2015调查中添加新的调查模块，该研究将确定MMC吸收的人际关系和社区级别的预测指标。此外，将进行定性的深入访谈和与男性的焦点小组讨论，以阐明某些男人这样做或不接受MC的原因。定性观察结果增强的定量证据将是R21/01制定有针对性策略以增加MMC吸收并增强MMC人群水平影响的基础。与候选人的现有定量技能相结合，行为科学理论和定性方法的培训将有助于候选人在促进与广泛的HIV预防性干预措施相关的健康行为方面建立独立的职业（例如MMC，ART，ART，ART，ART ART HIV PERET HIV CARE，PREP，PREP，PREP和PMTCT）。