Comparison of Three Intervention Models for Promoting Circumcision among Migrant Workers in Western China to Reduce Local Sexual Transmission of HIV

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

doi:10.1371/journal.pone.0076107

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

Introduction

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]

Methods

Results

Conclusion