TY - JOUR
T1 - Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention
T2 - A systematic review
AU - Atkins, Kaitlyn
AU - Yeh, Ping Teresa
AU - Kennedy, Caitlin E.
AU - Fonner, Virginia A.
AU - Sweat, Michael D.
AU - O’Reilly, Kevin R.
AU - Baggaley, Rachel
AU - Rutherford, George W.
AU - Samuelson, Julia
N1 - Funding Information:
The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. This work was funded by the Department of HIV, World Health Organization (https://www. who.int/hiv/en/), the Bill and Melinda Gates Foundation (https://www.gatesfoundation.org), and the US National Institute of Mental Health, grant number R01MH090173. Two WHO authors were involved in the study design, the decision to submit the article for publication, and interpretation of data, but not in the collection and analysis of data. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. We thank our research assistants from the Johns Hopkins Bloomberg School of Public Health (Melissa Camila Alamo, Afia Pokuaa Amoah, Belinda Jivapong, Holly Nishimura, and Leah Tanner) for their assistance screening citations and extracting data. We also thank the members of the WHO Guideline Development Group on updated recommendations on safe male circumcision for HIV prevention and related service delivery for adolescent boys and men in generalized HIV epidemics. We thank Carmen Figueroa who undertook initial scoping work that informed this study.
Publisher Copyright:
© 2020 Atkins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2020/1
Y1 - 2020/1
N2 - Background Voluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify. Methods We systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility. Results Four randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men’s uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies. Conclusions Innovative changes in male-centered VMMC services can improve adult men’s and adolescent boys’ VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation.
AB - Background Voluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify. Methods We systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility. Results Four randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men’s uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies. Conclusions Innovative changes in male-centered VMMC services can improve adult men’s and adolescent boys’ VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation.
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U2 - 10.1371/journal.pone.0227755
DO - 10.1371/journal.pone.0227755
M3 - Article
C2 - 31929587
AN - SCOPUS:85077765184
SN - 1932-6203
VL - 15
JO - PloS one
JF - PloS one
IS - 1
M1 - e0227755
ER -