Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: a mixed methods study.

Autor:	Matoga MM; University of North Carolina Project, Lilongwe, Malawi.; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Heath Sciences, University of the Witwatersrand, Johannesburg, South Africa., Kudowa E; University of North Carolina Project, Lilongwe, Malawi., Chikuni J; University of North Carolina Project, Lilongwe, Malawi., Tsidya M; University of North Carolina Project, Lilongwe, Malawi., Tseka J; University of North Carolina Project, Lilongwe, Malawi., Ndalama B; University of North Carolina Project, Lilongwe, Malawi., Bonongwe N; University of North Carolina Project, Lilongwe, Malawi., Mathiya E; University of North Carolina Project, Lilongwe, Malawi., Jere E; University of North Carolina Project, Lilongwe, Malawi., Yatina D; University of North Carolina Project, Lilongwe, Malawi., Kamtambe B; Bwaila STI clinic, Lilongwe District Health Office, Ministry of Health, Lilongwe, Malawi., Kapito M; Department of HIV, Viral Hepatitis and STIs, Ministry of Health, Lilongwe, Malawi., Hosseinipour MC; University of North Carolina Project, Lilongwe, Malawi.; Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Chasela CS; Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Heath Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Implementation Science Unit, Right to Care, Centurion, Pretoria, South Africa., Jewett S; Health and Society Division, School of Public Health, Faculty of Heath Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2024 Apr 04. Date of Electronic Publication: 2024 Apr 04.
DOI:	10.1101/2024.03.27.24304985
Abstrakt:	Introduction: Uptake of voluntary medical male circumcision (VMMC) remains a challenge in many settings. Innovative implementation strategies are required to scale-up VMMC uptake. Methodology: RITe was a multi-faceted intervention comprising transport reimbursement (R), intensified health education (IHE) and SMS/Telephone tracing (Te), which increased the uptake of VMMC among uncircumcised men with sexually transmitted infections (STIs) in Malawi. Using a concurrent exploratory mixed-method approach, we assessed the intervention's acceptability, feasibility and appropriateness among men with STIs and healthcare workers (HCWs) at Bwaila District Hospital. Participants completed Likert scale surveys and participated in-depth interviews (IDIs) and focus group discussions (FGDs). We calculated percentages of responses to survey items and summarized common themes using thematic analysis. Median scores and interquartile ranges (IQR) were calculated for acceptability, feasibility and appropriateness of each strategy at baseline and end-line and compared using the Wilcoxon signed rank test. Results: A total of 300 surveys, 17 IDIs and 4 FGDs were conducted with men and HCWs between baseline and end-line. The mean age for men in the survey was 29 years (SD ±8) and most were married/cohabiting (59.3%). Mean age for HCWs was 38.5 years (SD ±7), and most were female (59.1%). For acceptability, participants agreed that RITe was welcome, approvable, and likable. Despite participants agreeing that RITe was a good idea, culture and religion influenced appropriateness, particularly at baseline, which improved at end-line for Te and R. For feasibility, HCWs agreed that RITe was easy to implement, but expressed concerns that R (end-line median = 4, IQR: 2, 4) and Te (end-line median = 4, IQR: 4, 4), were resource intensive, hence unsustainable. Interviews corroborated the survey results. Participants reported that IHE provided important information, Te was a good reminder and R was attractive, but they reported barriers to R and Te such as electricity, limited access to phones and distrust in the government. Conclusions: The RITe intervention was acceptable, feasible and appropriate. However, culture/religion and structural barriers affected perceptions of appropriateness and feasibility, respectively. Continued awareness raising on VMMC and addressing setting-specific structural factors are required to overcome barriers that impede demand-creation interventions for VMMC. Study Registration: ClinicalTrials.gov identifier: NCT04677374. Registered on December 18, 2020.
Databáze:	MEDLINE
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