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Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial

BACKGROUND: Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in the...

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Autores principales: Downs, Jennifer A, Mwakisole, Agrey H, Chandika, Alphonce B, Lugoba, Shibide, Kassim, Rehema, Laizer, Evarist, Magambo, Kinanga A, Lee, Myung Hee, Kalluvya, Samuel E, Downs, David J, Fitzgerald, Daniel W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364327/
https://www.ncbi.nlm.nih.gov/pubmed/28214093
http://dx.doi.org/10.1016/S0140-6736(16)32055-4
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author Downs, Jennifer A
Mwakisole, Agrey H
Chandika, Alphonce B
Lugoba, Shibide
Kassim, Rehema
Laizer, Evarist
Magambo, Kinanga A
Lee, Myung Hee
Kalluvya, Samuel E
Downs, David J
Fitzgerald, Daniel W
author_facet Downs, Jennifer A
Mwakisole, Agrey H
Chandika, Alphonce B
Lugoba, Shibide
Kassim, Rehema
Laizer, Evarist
Magambo, Kinanga A
Lee, Myung Hee
Kalluvya, Samuel E
Downs, David J
Fitzgerald, Daniel W
author_sort Downs, Jennifer A
collection PubMed
description BACKGROUND: Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in their village. METHODS: In this cluster randomised trial in northwest Tanzania, eligible villages were paired by proximity (<60 km) and the time that a free male circumcision outreach campaign from the Tanzanian Ministry of Health became available in their village. All villages received the standard male circumcision outreach activities provided by the Ministry of Health. Within the village pairs, villages were randomly assigned by coin toss to receive either additional education for Christian church leaders on scientific, religious, and cultural aspects of male circumcision (intervention group), or standard outreach only (control group). Church leaders or their congregations were not masked to random assignment. The educational intervention consisted of a 1-day seminar co-taught by a Tanzanian pastor and a Tanzanian clinician who worked with the Ministry of Health, and meetings with the study team every 2 weeks thereafter, for the duration of the circumcision campaign. The primary outcome was the proportion of male individuals in a village who were circumcised during the campaign, using an intention-to-treat analysis that included all men in the village. This trial is registered with ClinicalTrials.gov, number NCT 02167776. FINDINGS: Between June 15, 2014, and Dec 10, 2015, we provided education for church leaders in eight intervention villages and compared the outcomes with those in eight control villages. In the intervention villages, 52·8% (30 889 of 58 536) of men were circumcised compared with 29·5% (25 484 of 86 492) of men in the eight control villages (odds ratio 3·2 [95% CI, 1·4–7·3]; p=0·006). INTERPRETATION: Education of religious leaders had a substantial effect on uptake of male circumcision, and should be considered as part of male circumcision programmes in other sub-Saharan African countries. This study was conducted in one region in Tanzania; however, we believe that our intervention is generalisable. We equipped church leaders with knowledge and tools, and ultimately each leader established the most culturally-appropriate way to promote male circumcision. Therefore, we think that the process of working through religious leaders can serve as an innovative model to promote healthy behaviour, leading to HIV prevention and other clinically relevant outcomes, in a variety of settings. FUNDING: Bill & Melinda Gates Foundation, National Institutes of Health, and the Mulago Foundation.
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spelling pubmed-53643272017-03-31 Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial Downs, Jennifer A Mwakisole, Agrey H Chandika, Alphonce B Lugoba, Shibide Kassim, Rehema Laizer, Evarist Magambo, Kinanga A Lee, Myung Hee Kalluvya, Samuel E Downs, David J Fitzgerald, Daniel W Lancet Articles BACKGROUND: Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in their village. METHODS: In this cluster randomised trial in northwest Tanzania, eligible villages were paired by proximity (<60 km) and the time that a free male circumcision outreach campaign from the Tanzanian Ministry of Health became available in their village. All villages received the standard male circumcision outreach activities provided by the Ministry of Health. Within the village pairs, villages were randomly assigned by coin toss to receive either additional education for Christian church leaders on scientific, religious, and cultural aspects of male circumcision (intervention group), or standard outreach only (control group). Church leaders or their congregations were not masked to random assignment. The educational intervention consisted of a 1-day seminar co-taught by a Tanzanian pastor and a Tanzanian clinician who worked with the Ministry of Health, and meetings with the study team every 2 weeks thereafter, for the duration of the circumcision campaign. The primary outcome was the proportion of male individuals in a village who were circumcised during the campaign, using an intention-to-treat analysis that included all men in the village. This trial is registered with ClinicalTrials.gov, number NCT 02167776. FINDINGS: Between June 15, 2014, and Dec 10, 2015, we provided education for church leaders in eight intervention villages and compared the outcomes with those in eight control villages. In the intervention villages, 52·8% (30 889 of 58 536) of men were circumcised compared with 29·5% (25 484 of 86 492) of men in the eight control villages (odds ratio 3·2 [95% CI, 1·4–7·3]; p=0·006). INTERPRETATION: Education of religious leaders had a substantial effect on uptake of male circumcision, and should be considered as part of male circumcision programmes in other sub-Saharan African countries. This study was conducted in one region in Tanzania; however, we believe that our intervention is generalisable. We equipped church leaders with knowledge and tools, and ultimately each leader established the most culturally-appropriate way to promote male circumcision. Therefore, we think that the process of working through religious leaders can serve as an innovative model to promote healthy behaviour, leading to HIV prevention and other clinically relevant outcomes, in a variety of settings. FUNDING: Bill & Melinda Gates Foundation, National Institutes of Health, and the Mulago Foundation. Elsevier 2017-03-18 /pmc/articles/PMC5364327/ /pubmed/28214093 http://dx.doi.org/10.1016/S0140-6736(16)32055-4 Text en © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Articles
Downs, Jennifer A
Mwakisole, Agrey H
Chandika, Alphonce B
Lugoba, Shibide
Kassim, Rehema
Laizer, Evarist
Magambo, Kinanga A
Lee, Myung Hee
Kalluvya, Samuel E
Downs, David J
Fitzgerald, Daniel W
Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial
title Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial
title_full Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial
title_fullStr Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial
title_full_unstemmed Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial
title_short Educating religious leaders to promote uptake of male circumcision in Tanzania: a cluster randomised trial
title_sort educating religious leaders to promote uptake of male circumcision in tanzania: a cluster randomised trial
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364327/
https://www.ncbi.nlm.nih.gov/pubmed/28214093
http://dx.doi.org/10.1016/S0140-6736(16)32055-4
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