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Increasing early infant male circumcision uptake in Zambia: Like father like son
Stephen M Weiss1, Violeta J Rodriguez1,2, Ryan R Cook3
1Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
Insights
The "Like Father, Like Son" pilot study successfully increased Early-Infant Medical Circumcision (EIMC) rates to 35% by offering combined services and couple interventions. This approach also boosted Voluntary Medical Male Circumcision (VMMC) uptake in older sons, demonstrating feasibility and effectiveness for HIV prevention.
Area of Science:
- Public Health
- HIV Prevention
- Maternal and Child Health
Background:
- Voluntary Medical Male Circumcision (VMMC) is a key HIV prevention strategy in high-prevalence areas.
- Zambia has a high annual birth rate of male neonates eligible for Early-Infant Medical Circumcision (EIMC).
- Previous EIMC programs in Zambia have shown lower uptake rates.
Purpose of the Study:
- To evaluate the feasibility and acceptability of offering combined EIMC and VMMC services.
- To assess the impact of couple-level behavioral interventions on circumcision uptake.
- To build upon successful implementation strategies from the Spear & Shield program.
Main Methods:
- Pilot study involving 351 couples (702 participants) in Zambia.
- Intervention included combined EIMC/VMMC services and couple-level behavioral interventions.
- Data collection occurred pre-birth, 2 weeks post-birth, and 6 months post-birth.
Main Results:
- Achieved a 35% EIMC rate, significantly higher than previous Zambian studies (11%).
- Observed a 31% increase in VMMC odds for older sons post-intervention and 90% at 2 weeks post-birth.
- The 'Like Father, Like Son' (LFLS) intervention proved feasible, acceptable, and effective.
Conclusions:
- The LFLS intervention effectively doubled EIMC rates compared to previous longitudinal studies in Zambia.
- A family-centric approach may enhance male circumcision promotion for infants and adolescents.
- Father-son bonding through circumcision status could be a novel strategy for increasing EIMC and VMMC uptake.
Abstract:
Voluntary Medical Male Circumcision (VMMC) is an effective strategy for HIV prevention in areas with high prevalence of, and risk for, HIV. More than 361,000 male neonates are born each year in Zambia, many of whom could be eligible for Early-Infant Medical Circumcision (EIMC). Building on successful implementation strategies utilized in our Spear & Shield program, this pilot study, "Like Father, Like Son" (LFLS), evaluated the feasibility and acceptability of offering combined EIMC and VMMC services and couple-level behavioral interventions. A total of N = 702 pregnant women and their male partners (n = 351 couples) were recruited and enrolled. Couples were assessed twice pre-birth, 2 weeks post birth, and 6 months post birth. Expectant mothers were an average of 15.05 weeks pregnant (SD = 8.83). Thirty-nine pregnancies did not result in a live birth (11%), 14 couples withdrew from the study or were lost to follow-up prior to delivery (4%), and 148 babies were born female (42%), leaving 150 couples with a male infant in the analytic sample (43%). The LFLS study achieved significantly higher EIMC rates (35%) in comparison with previously observed EIMC study rates in Zambia (11%), and significantly higher than hypothetical comparison rates up to 30%. Relative to baseline rates, odds of VMMC among couples' older sons increased by 31% at post-intervention and by 90% at two-weeks following birth. Overall, this pilot study found the LFLS intervention to be feasible, acceptable, and effective in doubling the rate of EIMC in comparison with a previous longitudinal study in Zambia. Future research should consider a family-centric approach to promotion of male circumcision for infants and adolescents. LFLS may be effective in promoting father-son "bonding" by MC status; a bond that may be a bridge to increase both EIMC and VMMC uptake in newborns and couples' older sons and is a novel leverage point for promotion of this HIV prevention strategy.
