Salim S. Abdool Karim, MD, PhD reviewing Downs JA et al. Lancet 2017 Feb 14.
In Tanzanian villages where religious leaders were educated about medical male circumcision, uptake of medical male circumcision was significantly higher than in villages without such education.
Voluntary medical male circumcision (VMMC) is a cost-effective HIV prevention intervention providing lifelong partial protection against female-to-male HIV transmission. Despite dramatic scale-up of VMMC in 14 priority countries in eastern and southern Africa that have high levels of HIV prevalence and had low levels of male circumcision, the annual numbers of circumcisions must more than double over the next 3 years to reach the UNAIDS 2020 target of 25 million young men in high-prevalence settings being circumcised.
Researchers conducted this community-based, cluster-randomized trial in 16 villages in Tanzania to test whether equipping religious leaders with knowledge and tools about VMMC would increase circumcision uptake. All villages were receiving medical services to provide circumcision during the trial period. In the eight intervention villages that received the education intervention, 52.8% (30,889 of 58,536) of the men were circumcised, compared with 29.5% (25,484 of 86,492) in the eight villages that did not receive the education intervention, a significant difference (odds ratio, 3.2; 95% confidence interval, 1.4–7.3). In intervention villages, 30.8% of men undertook VMMC because of the discussions about VMMC at church, significantly more than the 0.7% in control villages. Further, compared with control villages, in intervention villages wives and girlfriends were significantly more likely to encourage their partners to seek circumcision. The impact of the education intervention remained significant (OR, 1.8; 95% CI, 1.2–2.9) after removing one village pair that showed the largest difference between intervention and control and after varying the estimated number of men who were already circumcised at baseline.
CITATION(S):
Downs JA et al. Educating religious leaders to promote uptake of male circumcision in Tanzania: A cluster randomised trial. Lancet 2017 Feb 14; [e-pub].
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