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Abstract
ObjectiveThree models for promoting male circumcision (MC) as a preventative intervention against HIV infection were compared among migrant worker populations in western China.MethodsA 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.ResultsAll 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).ConclusionsA 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.
Highlights
Epidemiological evidence indicates that the epidemic of HIV/ AIDS in China has seen a distinct increase in heterosexual transmission in recent years [1,2,3]
A total of 1,670 male migrants were cluster-randomized by work site into three intervention groups: on-site session model (n = 487), two-stage intervention model (n = 547), and threestage model (n = 636)
We found that work-site based interventions improved knowledge about male circumcision (MC) among Western Chinese migrant workers regardless of the intervention model employed, while the three-stage model was the most effective in promoting MC surgery uptake as well as the most cost-effective
Summary
Epidemiological evidence indicates that the epidemic of HIV/ AIDS in China has seen a distinct increase in heterosexual transmission in recent years [1,2,3]. An estimated 740,000 people are living with HIV/AIDS in China, 27% of which are found in three western provinces and municipalities Xinjiang, Guangxi and Chongqing, which only contains 7.5% of China’s total population [4]. In Chongqing, Guangxi and Yunnan province, the proportion of men infected with HIV via sexual contact increased from 7.3% in 2000 to 45% in 2009 [5]. One goal outlined in the 2006–2010 National Five-Year Action Plan was that 70% of China’s migrant population should be reached by educational interventions on HIV/AIDS and should understand HIV transmission and prevention [11]
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