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

巴布亚原住民自愿医疗男性包皮环切术 (VMMC) 模式

• 批准号: 10079975
• 负责人: Robert Converse Bailey
• 金额: $ 17.94万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-07 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10079975
• 关键词: AIDS prevention; Abstinence; Adolescent; Adopted; Adult; Affect; Age; Attention; Bacterial Vaginosis; Behavior; Cities; Clinic; Clinical Trials; Communities; Community Health Systems; Consultations; Counseling; Country; Data; Device Removal; Devices; Education; Elderly; Ensure; Epidemic; Ethnic group; Event; Excision; Exposure to; Female; Focus Groups; General Population; Genital system; Government; Government Programs; HIV; HIV Infections; Health; Healthcare Systems; Heterosexuals; Human Papillomavirus; Incidence; Indigenous; Indonesia; Infection; Injecting drug user; International; Intervention; Interview; Island; Life; Location; Male Adolescents; Male Circumcision; Medical; Modeling; Muslim population group; Operative Surgical Procedures; Outcome Study; Parents; Perception; Policies; Population; Prevalence; Prevention; Prevention strategy; Preventive; Procedures; Provider; Province; Questionnaires; Recommendation; Religious Belief; Research; Resources; Rest; Risk; Safe Sex; Safety; Schools; Services; Sex Behavior; Sexual Health; Sexual Partners; Testing; Time; Training; Ulcer; Voluntary Programs; Youth; base; boys; cost effectiveness; design; experience; high risk; male; member; men; men who have sex with men; penis foreskin; prevention service; primary outcome; programs; response; satisfaction; secondary outcome; sexual HIV transmission; sexual risk behavior; sexual risk taking; success; transmission process; uptake

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.

抽象的 艾滋病毒感染者的人数继续在印度尼西亚，尤其是在塔纳省 巴布亚的预防措施基于禁欲或更安全的性行为仅显示出适度的成功，并准备 不被政府批准使用。自愿医疗男性电路（VMMC）作为一次性程序 通过临床试验显示了HA，以降低男性异性获得HIV感染的风险 约60％。目前，Tanah Papua尚未提供VMMC，与印度尼西亚其他地区不同， 绝大多数男人都没有割礼。这项研究将开发，实施和评估可行性， VMMC的巴布亚土著模型（PIM）的可接受性和安全性是一种全面的，文化和 针对12-18岁的巴布亚男性，适合艾滋病毒的艾滋病毒干预措施。包皮环切术会提供部分生命的艾滋病毒 保护和宝贵的机会，让青春期男性通过医疗保健系统进行灌输 艾滋病毒预防行为。该研究的4个目标：目标1：与巴布亚社区成员探索 可接受性，障碍和促进者引入基于学校的年龄和适当的文化， 全面的VMMC干预措施以减少巴布亚人口的艾滋病毒发病率。目标2：评估 社区卫生系统符合国际安全综合VMMC服务标准的能力 并确保在某些诊所中满足这些标准所必需的资源和培训。目的 3：根据目标1和2中收集的信息以及在 与社区顾问委员会，卫生部和教育部协商。目标4：到 试点测试VMMC的基于学校的PIM干预，有400名12-18岁的男孩在两种HIV高危 巴布亚人地点：纳比尔和贾亚布拉。数据将通过焦点小组，深入的访谈收集 在关键的社区利益相关者和青少年的情况下，对青少年男性进行了简短的问卷调查 手术后6周，由30名男孩进行了随机采访，在设备拆除后12周采访到 检测满意度的变化，性活动发作以及可能的补偿性风险。 父母面试将衡量他们的满意度。主要结果是青春期男性的比例 接触以学校为基础的PIM VMMC教育和信息性会议，他们获得电路和外科手术 事件安全。次要结果是青少年男性和父母的满意，其中的任何性活动 巡回赛后6周，基线和12周之间的性风险行为发生变化 在MC培训和实施，设备的易用性以及 遇到的挑战。这项研究的影响在于已经开发并严格测试了 在巴布亚为12-18岁的青少年男性的VMMC服务的文化适合和年龄范围的模型， 在其他艾滋病毒预防服务很难实施且流行病也很棘手的地方。