PLoS ONE (Jan 2013)

Comparison of three intervention models for promoting circumcision among migrant workers in western China to reduce local sexual transmission of HIV.

  • Chuanyi Ning,
  • Junjun Jiang,
  • Li Ye,
  • Xiaobo Yang,
  • Bo Wei,
  • Wei Deng,
  • Suosu Wei,
  • Jiegang Huang,
  • Bo Qin,
  • Halmurat Upur,
  • Chaohui Zhong,
  • Qianqiu Wang,
  • Qian Wang,
  • Yuhua Ruan,
  • Fumei Wei,
  • Na Xu,
  • Peiyan Xie,
  • Jenny H Hsi,
  • Yiming Shao,
  • Hao Liang

DOI
https://doi.org/10.1371/journal.pone.0076107
Journal volume & issue
Vol. 8, no. 9
p. e76107

Abstract

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OBJECTIVE: Three models for promoting male circumcision (MC) as a preventative intervention against HIV infection were compared among migrant worker populations in western China. METHODS: A cohort study was performed after an initial cross-sectional survey among migrant workers in three provincial level districts with high HIV prevalence in western China. A total of 1,670 HIV seronegative male migrants were cluster-randomized into three intervention models, in which the dissemination of promotional materials and expert- and volunteer-led discussions are conducted in one, two, and three stage interventions. Changes in knowledge of MC, acceptability of MC, MC surgery uptake, and the costs of implementation were analyzed at 6-month and 9-month follow-up visits. RESULTS: All three models significantly increased the participants' knowledge about MC. The three-stage model significantly increased the acceptability of MC among participants and led to greatest increase in MC uptake. At the end of follow-up, 9.2% (153/1,670) of participants underwent MC surgery; uptake among the one-, two-, and three-stage models were 4.9%, 9.3%, and 14.6%, respectively. Multivariable Cox regression analysis showed that three-stage model was the most effective method to scale up MC, with RR = 2.0 (95% CI, 1.3-3.1, P=0.002) compared to the on-site session model. The two-stage intervention model showed no significant difference with either the on-site session model (RR=1.5, 95% CI, 0.92-2.4, P=0.12) or three-stage model (P=0.10). CONCLUSIONS: A three-stage intervention with gradual introduction of knowledge led to the significantly increase in MC uptake among migrant workers in western China, and was also the most cost-effective method among the three models.