Application of an HIV prevention cascade to identify gaps in increasing coverage of voluntary medical male circumcision services in 42 rural Zambian communities

Bernadette Hensen, Elizabeth Fearon, Ab Schaap, James J Lewis, Helen A Weiss, Margaret Tembo, Namwinga Chintu, Helen Ayles, James R Hargreaves

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Abstract

Increased coverage of voluntary medical male circumcision (VMMC) is needed in countries with high HIV prevalence. We applied an HIV-prevention cascade to identify gaps in male circumcision coverage in Zambia. We used survey data collected in 2013 and 2014/15 to describe circumcision coverage at each time-point, and prevalence of variables related to demand for and supply of VMMC. We explored whether circumcision coverage in 2014/15 was associated with demand and supply among uncircumcised men in 2013. Results show that circumcision coverage was 11.5% in 2013 and 18.0% in 2014/15. Levels of having heard of circumcision and agreeing with prevention benefits was similar at both time-points (79.8% vs 83.2%, and 49.7% vs 50.7%, respectively). In 2013, 39.3% of men perceived services to be available compared to 54.7% in 2014/15. Levels of having heard of circumcision in 2013 was correlated with and higher perceived service availability associated with coverage in 2014/15. VMMC coverage was low in these study sites. Knowledge of prevention tools and of service availability are necessary to increase coverage but alone are insufficient.

Original languageEnglish
JournalAIDS and Behavior
Volume23
Issue number5
Pages (from-to)1095-1103
Number of pages9
ISSN1090-7165
DOIs
Publication statusPublished - 2019

Keywords

  • Adolescent
  • Adult
  • Circumcision, Male/statistics & numerical data
  • Cluster Analysis
  • Delivery of Health Care/organization & administration
  • HIV Infections/prevention & control
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Preventive Health Services/organization & administration
  • Rural Population
  • Voluntary Programs
  • Young Adult
  • Zambia/epidemiology

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