Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe
Identifieur interne : 000B19 ( Main/Exploration ); précédent : 000B18; suivant : 000B20Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe
Auteurs : Sema K. Sgaier [États-Unis] ; Sunny Sharma [Royaume-Uni] ; Maria Eletskaya [Royaume-Uni] ; Ram Prasad [Inde] ; Owen Mugurungi [Zimbabwe] ; Bushimbwa Tambatamba [Zambie] ; Getrude Ncube [Zimbabwe] ; Sinokuthemba Xaba [Zimbabwe] ; Alice Nanga [Royaume-Uni] ; Sehlulekile Gumede-Moyo [Royaume-Uni] ; Steve Kretschmer [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Abstract
As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.
Url:
DOI: 10.1371/journal.pone.0181411
PubMed: 28749979
PubMed Central: 5531536
Affiliations:
- Inde, Royaume-Uni, Zambie, Zimbabwe, États-Unis
- Angleterre, Grand Londres, Massachusetts, Washington (État)
- Londres, Seattle
- Université de Washington
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: 002960
- to stream Pmc, to step Curation: 002959
- to stream Pmc, to step Checkpoint: 000314
- to stream Ncbi, to step Merge: 004481
- to stream Ncbi, to step Curation: 004481
- to stream Ncbi, to step Checkpoint: 004481
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Le document en format XML
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<front><div type="abstract" xml:lang="en"><p>As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side will need to be addressed.</p>
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<author><name sortKey="Gold, E" uniqKey="Gold E">E Gold</name>
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<author><name sortKey="Mahler, H" uniqKey="Mahler H">H Mahler</name>
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<author><name sortKey="Kripke, K" uniqKey="Kripke K">K Kripke</name>
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<author><name sortKey="Seifert Ahanda, K" uniqKey="Seifert Ahanda K">K Seifert-Ahanda</name>
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<author><name sortKey="Mavhu, W" uniqKey="Mavhu W">W Mavhu</name>
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<author><name sortKey="Hatzold, K" uniqKey="Hatzold K">K Hatzold</name>
</author>
<author><name sortKey="Biddle, Ak" uniqKey="Biddle A">AK Biddle</name>
</author>
<author><name sortKey="Madidi, N" uniqKey="Madidi N">N Madidi</name>
</author>
<author><name sortKey="Ncube, G" uniqKey="Ncube G">G Ncube</name>
</author>
</analytic>
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</author>
<author><name sortKey="Larke, N" uniqKey="Larke N">N Larke</name>
</author>
<author><name sortKey="Hatzold, K" uniqKey="Hatzold K">K Hatzold</name>
</author>
<author><name sortKey="Ncube, G" uniqKey="Ncube G">G Ncube</name>
</author>
<author><name sortKey="Weiss, Ha" uniqKey="Weiss H">HA Weiss</name>
</author>
<author><name sortKey="Mangenah, C" uniqKey="Mangenah C">C Mangenah</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Plank, Rm" uniqKey="Plank R">RM Plank</name>
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<author><name sortKey="Wirth, Ke" uniqKey="Wirth K">KE Wirth</name>
</author>
<author><name sortKey="Ndubuka, No" uniqKey="Ndubuka N">NO Ndubuka</name>
</author>
<author><name sortKey="Abdullahi, R" uniqKey="Abdullahi R">R Abdullahi</name>
</author>
<author><name sortKey="Nkgau, M" uniqKey="Nkgau M">M Nkgau</name>
</author>
<author><name sortKey="Lesetedi, C" uniqKey="Lesetedi C">C Lesetedi</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Plank, Rm" uniqKey="Plank R">RM Plank</name>
</author>
<author><name sortKey="Makhema, J" uniqKey="Makhema J">J Makhema</name>
</author>
<author><name sortKey="Kebaabetswe, P" uniqKey="Kebaabetswe P">P Kebaabetswe</name>
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<author><name sortKey="Hussein, F" uniqKey="Hussein F">F Hussein</name>
</author>
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<author><name sortKey="Halperin, D" uniqKey="Halperin D">D Halperin</name>
</author>
</analytic>
</biblStruct>
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</author>
<author><name sortKey="Mupambireyi, Z" uniqKey="Mupambireyi Z">Z Mupambireyi</name>
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<author><name sortKey="Hart, G" uniqKey="Hart G">G Hart</name>
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<author><name sortKey="Cowan, Fm" uniqKey="Cowan F">FM Cowan</name>
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</biblStruct>
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<author><name sortKey="Mugisa, B" uniqKey="Mugisa B">B Mugisa</name>
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<author><name sortKey="Bowa, K" uniqKey="Bowa K">K Bowa</name>
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<author><name sortKey="Linyama, D" uniqKey="Linyama D">D Linyama</name>
</author>
<author><name sortKey="Stringer, E" uniqKey="Stringer E">E Stringer</name>
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</analytic>
</biblStruct>
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<author><name sortKey="Sherman, J" uniqKey="Sherman J">J Sherman</name>
</author>
<author><name sortKey="Tengende, Br" uniqKey="Tengende B">BR Tengende</name>
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</author>
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</TEI>
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<li>Royaume-Uni</li>
<li>Zambie</li>
<li>Zimbabwe</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Grand Londres</li>
<li>Massachusetts</li>
<li>Washington (État)</li>
</region>
<settlement><li>Londres</li>
<li>Seattle</li>
</settlement>
<orgName><li>Université de Washington</li>
</orgName>
</list>
<tree><country name="États-Unis"><noRegion><name sortKey="Sgaier, Sema K" sort="Sgaier, Sema K" uniqKey="Sgaier S" first="Sema K." last="Sgaier">Sema K. Sgaier</name>
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<name sortKey="Kretschmer, Steve" sort="Kretschmer, Steve" uniqKey="Kretschmer S" first="Steve" last="Kretschmer">Steve Kretschmer</name>
<name sortKey="Sgaier, Sema K" sort="Sgaier, Sema K" uniqKey="Sgaier S" first="Sema K." last="Sgaier">Sema K. Sgaier</name>
<name sortKey="Sgaier, Sema K" sort="Sgaier, Sema K" uniqKey="Sgaier S" first="Sema K." last="Sgaier">Sema K. Sgaier</name>
</country>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Sharma, Sunny" sort="Sharma, Sunny" uniqKey="Sharma S" first="Sunny" last="Sharma">Sunny Sharma</name>
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<name sortKey="Eletskaya, Maria" sort="Eletskaya, Maria" uniqKey="Eletskaya M" first="Maria" last="Eletskaya">Maria Eletskaya</name>
<name sortKey="Gumede Moyo, Sehlulekile" sort="Gumede Moyo, Sehlulekile" uniqKey="Gumede Moyo S" first="Sehlulekile" last="Gumede-Moyo">Sehlulekile Gumede-Moyo</name>
<name sortKey="Nanga, Alice" sort="Nanga, Alice" uniqKey="Nanga A" first="Alice" last="Nanga">Alice Nanga</name>
</country>
<country name="Inde"><noRegion><name sortKey="Prasad, Ram" sort="Prasad, Ram" uniqKey="Prasad R" first="Ram" last="Prasad">Ram Prasad</name>
</noRegion>
</country>
<country name="Zimbabwe"><noRegion><name sortKey="Mugurungi, Owen" sort="Mugurungi, Owen" uniqKey="Mugurungi O" first="Owen" last="Mugurungi">Owen Mugurungi</name>
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<name sortKey="Ncube, Getrude" sort="Ncube, Getrude" uniqKey="Ncube G" first="Getrude" last="Ncube">Getrude Ncube</name>
<name sortKey="Xaba, Sinokuthemba" sort="Xaba, Sinokuthemba" uniqKey="Xaba S" first="Sinokuthemba" last="Xaba">Sinokuthemba Xaba</name>
</country>
<country name="Zambie"><noRegion><name sortKey="Tambatamba, Bushimbwa" sort="Tambatamba, Bushimbwa" uniqKey="Tambatamba B" first="Bushimbwa" last="Tambatamba">Bushimbwa Tambatamba</name>
</noRegion>
</country>
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</affiliations>
</record>
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