Effectiveness of an "Exclusive Intervention Strategy" to increase medical male circumcision uptake among men aged 25-49 years in South Africa

Abstract

Background: South Africa introduced medical male circumcision (MMC) to reduce HIV incidence. Mathematical modeling suggested that targeting MMC services to men aged 20-34 years could provide the most immediate impact on HIV incidence. However the majority of MMCs performed have been among males aged ≤25 years. We evaluated an intervention package to increase MMC uptake among men aged 25-49 years.

Methods: We conducted a pre-post study to compare the proportion of men (aged 25-49 years) presenting for MMC during the formative (Phase 1) and intervention (Phase 2) phases in Ekurhuleni, Johannesburg, South Africa. The intervention included infrastructure changes that separated adults from adolescents at the MMC site, an exclusive men's health club, adult-specific demand generation materials, and discussions with community members.

Results: Overall 2817 enrolled in the study with 1601 from Phase 1 and 1216 in Phase 2. A higher proportion of participants aged 25-49 years accessed MMC in Phase 2 compared to Phase 1 (59.4% vs. 54.9%; Prevalence Ratio = 1.08; 95% Confidence Interval: 1.01-1.15; p = 0.019). Participants with multiple partners in the past 12 months in Phase 2 were more likely to access MMC services compared to participants in Phase 1 (unadjusted Odds Ratio, 1.37; 95% CI:1.17-1.61; p < 0.001). After adjusting for age, multiple partners remained a risk factor in Phase 2 (adjusted OR, 1.39; 95% CI: 1.18-1.63; p < 0.001).

Conclusions: The "Exclusive Intervention Strategy" was associated with a slight increase in the proportion of participants aged 25-49 years accessing MMC services, and an increase in those with HIV risk behaviors, during the intervention phase. These findings may provide important insights to overcoming barriers for accessing MMC services among men aged 25-49 years.

Trial registration: The study is registered at ClinicalTrials.gov , number NCT02352961 .

Keywords: Demand creation; HIV prevention; Male circumcision; South Africa.

Conflict of interest statement

Ethics approval and consent to participate

We obtained approval for the study from the Witwatersrand Human Research Ethics Committee, University of Witwatersrand (Approval Number: M130711) and the research committee of the Centers for Disease Control and Prevention (protocol number 6546). The study was registered on Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

The funder of the study participated in the study design, data interpretation, and writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Figures

Fig. 1

Flow of enrolment diagram for Phase 1 and Phase 2 of the Imbizo study

Fig. 2

Number of MMC clients recruited per month for Phase 1 (April–September 2014) & Phase 2 (June–November 2015)