Male circumcision uptake during the Botswana Combination Prevention Project

Introduction Voluntary medical male circumcision (VMMC) uptake has been slow in some countries, including Botswana. To inform demand creation efforts, we examined sociodemographic characteristics and referral procedures associated with VMMC uptake in the Botswana Combination Prevention Project (BCPP) and examined the effectiveness of referral of men to MC services from HIV testing venues. Design BCPP was a community-randomized trial evaluating the impact of a combination HIV prevention package which included VMMC on community HIV incidence. We conducted a sub-analysis of VMMC uptake in intervention communities. Methods During the initial VMMC campaign in 15 intervention communities, baseline male circumcision (MC) status was assessed among men eligible for HIV testing. Uncircumcised male community residents aged 16–49 years with negative/unknown HIV status were mobilized and linked to study VMMC services. Outcomes included MC baseline status and uptake through study services. Univariate and multivariate logistic regressions were performed to identify factors associated with MC uptake. Results Of 12,864 men eligible for testing, 50% (n = 6,448) were already circumcised. Among the uncircumcised men (n = 6,416), 10% (n = 635) underwent MC. Of the 5,071 men identified as eligible for MC through HIV testing services, 78% declined referral and less than 1% of those were circumcised. Of those accepting referral (n = 1,107), 16% were circumcised. Younger (16–24 years) (aOR: 1.51; 95%CI:1.22,1.85), unemployed men (aOR:1.34; 95%CI: 1.06,1.69), and those undergoing HIV testing at mobile venues (aOR: 1.88; 95%CI: 1.53,2.31) were more likely to get circumcised. Fear of pain was the most prevalent (27%) reason given for not being circumcised. Conclusion Younger, unemployed men seeking HIV testing at mobile sites in Botswana were more likely to get VMMC. Addressing unique barriers for employed and older men may be necessary. Given the simplicity of VMMC as an intervention, the HIV testing programs offer a platform for identifying uncircumcised men and offering information and encouragement to access services.

[1]  E. T. Tchetgen Tchetgen,et al.  Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie/BCPP): a cluster-randomised trial. , 2020, The lancet. HIV.

[2]  F. Mbengo,et al.  Perceived influence of value systems on the uptake of voluntary medical male circumcision among men in Kweneng East, Botswana , 2020, SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance.

[3]  S. Lockman,et al.  Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project , 2019, PloS one.

[4]  E. T. Tchetgen Tchetgen,et al.  Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana. , 2019, The New England journal of medicine.

[5]  E. Njeuhmeli,et al.  Voluntary Medical Male Circumcision to Prevent HIV: Modelling Age Prioritization in Namibia , 2019, AIDS and Behavior.

[6]  K. Wirth,et al.  Immediate Motivators to Seeking Voluntary Medical Male Circumcision Among HIV-Negative Adult Men in an Urban Setting in Botswana. , 2019, AIDS education and prevention : official publication of the International Society for AIDS Education.

[7]  Arielle Lasry,et al.  Cost of Community-Based HIV Testing Activities to Reach Saturation in Botswana , 2019, AIDS and Behavior.

[8]  R. Ridzon,et al.  Progress in voluntary medical male circumcision for HIV prevention supported by the US President’s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data , 2018, BMJ Open.

[9]  K. Wirth,et al.  Modifying the health system to maximize voluntary medical male circumcision uptake: a qualitative study in Botswana , 2017, HIV/AIDS.

[10]  K. Wirth,et al.  A prospective cohort study of safety and patient satisfaction of voluntary medical male circumcision in Botswana , 2017, PloS one.

[11]  Kemist Shumba,et al.  Cultural competence: a framework for promoting voluntary medical male circumcision among VaRemba communities in Zimbabwe , 2017, African journal of AIDS research : AJAR.

[12]  M. Keetile,et al.  Factors associated with acceptability of child circumcision in Botswana -- a cross sectional survey , 2016, BMC Public Health.

[13]  A. Tobian,et al.  Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review , 2016, PloS one.

[14]  M. Daniel,et al.  Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing , 2015, Global public health.

[15]  Bruce Rhodes,et al.  Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu–Natal, South Africa , 2014, African journal of AIDS research : AJAR.

[16]  M. Magowe,et al.  Impediments for the Uptake of the Botswana Government's Male Circumcision Initiative for HIV Prevention , 2013, TheScientificWorldJournal.

[17]  S. Morin,et al.  Understanding and addressing socio-cultural barriers to medical male circumcision in traditionally non-circumcising rural communities in sub-Saharan Africa , 2013, Culture, health & sexuality.

[18]  田村 大輔,et al.  Centers for Disease Control and Prevention(CDC)での生活 , 2013 .

[19]  S. Lockman,et al.  Acceptability of Male Circumcision Among Adolescent Boys and their Parents, Botswana , 2012, AIDS and Behavior.

[20]  T. Moeti,et al.  The cost and impact of male circumcision on HIV/AIDS in Botswana , 2009, Journal of the International AIDS Society.

[21]  Stephen Moses,et al.  Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial , 2007, The Lancet.

[22]  Oliver Laeyendecker,et al.  Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial , 2007, The Lancet.

[23]  Emmanuel Lagarde,et al.  Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial , 2005, PLoS medicine.