title: Assessment of Different Intervention Models of Male Circumcision and Their Preliminary Effectiveness in Reducing HIV Incidence Among Drug Users in Western China.
abstract: World Health Organization (WHO) and Joint United Nations Program on AIDS (UNAIDS) recommend male circumcision (MC) as an additional HIV prevention measure. This study aimed to assess three models of promoting MC and their effects on preventing HIV infection among drug users in western China. We carried out a cohort study in three provinces of western China. HIV seronegative male drug users were recruited from methadone maintenance therapy clinics and cluster randomized into three intervention models. At baseline, 6, and 9 months of follow-up, changes in MC knowledge, the acceptability of MC, MC surgery uptake, and the costs of model implementation were analyzed. Of 1,304 male drug users who were screened, 1,218 were enrolled in the study. The participants' knowledge about MC was significantly increased after interventions by all three models. The one-stage model led to the highest increase in MC acceptability and the greatest increase in MC uptake. Multivariable Cox regression analysis showed that the one-stage model was also the most effective method to promote MC uptake, compared with the two-stage model [rate ratio (RR) = 0.602; 95% confidence interval (CI), 0.420-0.862] and three-stage model (RR = 0.555; 95% CI, 0.382-0.807). The HIV incidence rate in the MC group was lower than that in the non-MC group (RR = 0.234; 95% CI, 0.056-0.974). Moreover, the one-stage model required the lowest cost per circumcision. The one-stage model is the most effective and the most cost-effective intervention to increase MC uptake among male drug users in western China and could decrease the HIV incidence rate, based on a short follow-up investigation.
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Jiegang
authors.initials: J
authors.lastname: Huang
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Junjun
authors.initials: J
authors.lastname: Jiang
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Yang
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Bingyu
authors.initials: B
authors.lastname: Liang
authors.affiliation: 2 The First Affiliated Hospital, Chongqing Medical University , Chongqing, China .
authors.forename: Bo
authors.initials: B
authors.lastname: Qin
authors.affiliation: 3 School of Public Health, Xinjiang Medical University , Urumqi, China .
authors.forename: Halmurat
authors.initials: H
authors.lastname: Upur
authors.affiliation: 4 School of Public Health, Chongqing Medical University , Chongqing, China .
authors.forename: Chaohui
authors.initials: C
authors.lastname: Zhong
authors.affiliation: 5 National Center for STD Control, China Centers for Disease Control and Prevention , Nanjing, China .
authors.forename: Qianqiu
authors.initials: Q
authors.lastname: Wang
authors.affiliation: 3 School of Public Health, Xinjiang Medical University , Urumqi, China .
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.affiliation: 6 State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China .
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Wei
authors.initials: W
authors.lastname: Deng
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Peiyan
authors.initials: P
authors.lastname: Xie
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Liao
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Na
authors.initials: N
authors.lastname: Xu
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Zou
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Fumei
authors.initials: F
authors.lastname: Wei
authors.affiliation: 1 Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Li
authors.initials: L
authors.lastname: Ye
authors.affiliation: 7 Guangxi Key Laboratory of AIDS Prevention and Treatment & Life Sciences Institute, Guangxi Medical University , Nanning, Guangxi, China .
authors.forename: Hao
authors.initials: H
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D002944:Circumcision, Male / Q000379:methods* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D055030:Drug Users; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D016896:Treatment Outcome; D055815:Young Adult
keywords: AIDS; China; Guangxi; HIV; circumcision; drug user