title: Obtaining a male circumcision prevalence rate of 80% among adults in a short time: An observational prospective intervention study in the Orange Farm township of South Africa.
abstract: World Health Organization recommends a target for the male circumcision prevalence rate of 80%. This rate will have a substantial impact on the human immunodeficiency virus-acquired immunodeficiency syndrome epidemic in Eastern and Southern Africa. The objective of the study was to assess whether an innovative intervention can lead to an increased voluntary male medical circumcision (VMMC) uptake among adults in a short time. This prospective observational study of a demand generation intervention was conducted in the township of Orange Farm (South Africa) in August to November 2015. In this community male circumcision prevalence rate among adults was stable between 2010 and 2015 at 55% and 57%, despite regular VMMC campaigns at community level and the presence of a VMMC clinic that offered free VMMC. The intervention took place in a random sample of 981 households where 522 men aged 18 to 49 years accepted to participate in the study. Among the 226 uncircumcised men, 212 accepted to be enrolled in the intervention study. A personal male circumcision adviser trained in interpersonal communication skills was assigned to each uncircumcised participant. The male circumcision advisers were trained to explain the risks and benefits of VMMC, and to discuss 24 possible reasons given by men for not being circumcised. Participants were then followed for 9 weeks. Each participant had a maximum of 3 motivational interviews at home. Participants who decided to be circumcised received financial compensation for their time equivalent to 2.5 days of work at the minimum South African salary rate. Among the 212 uncircumcised men enrolled in the intervention, 69.8% (148/212; 95% confidence interval [CI]; 63.4%-75.7%) agreed to be circumcised, which defines the uptake of the intervention. The male circumcision prevalence rate of the sample increased from 56.7% (296/522) to 81.4% (425/522; 77.9%-84.6%), P < 0.001, corresponding to a relative increase of 43.6% (95% CI: 35.4%-53.7%). The reported reasons for accepting circumcision were motivational interviews with the male circumcision adviser (83.1%), and time compensation (39.4%).Increased uptake of VMMC uptake can be obtained in a short time among adult males but requires an intense intervention centered on uncircumcised men at an individual level and time compensation.
authors.affiliation: INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris EA 4184, Faculty of Medicine, University of Burgundy, Dijon, France Progressus Research & Development CHAPS, Johannesburg, South Africa Médecins Sans Frontières, Paris, France National Institute for Communicable Diseases, National Health Laboratory Service Division of Virology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Paris Faculty of Medicine, University of Versailles-Saint Quentin, Versailles, France.
authors.forename: Esaie
authors.initials: E
authors.lastname: Marshall
authors.forename: Reathe
authors.initials: R
authors.lastname: Rain-Taljaard
authors.forename: Motlalepule
authors.initials: M
authors.lastname: Tsepe
authors.forename: Cornelius
authors.initials: C
authors.lastname: Monkwe
authors.forename: Dirk
authors.initials: D
authors.lastname: Taljaard
authors.forename: Florence
authors.initials: F
authors.lastname: Hlatswayo
authors.forename: Dumazile
authors.initials: D
authors.lastname: Xaba
authors.forename: Tebogo
authors.initials: T
authors.lastname: Molomo
authors.forename: Pascale
authors.initials: P
authors.lastname: Lissouba
authors.forename: Adrian
authors.initials: A
authors.lastname: Puren
authors.forename: Bertran
authors.initials: B
authors.lastname: Auvert
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000523:psychology / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult