Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.632003
Title: Feasibility and acceptability of early infant male circumcision as an HIV prevention intervention in Zimbabwe
Author: Mavhu, W.
ISNI:       0000 0004 5358 6199
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2014
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Abstract:
The overall aim of the research outlined in this PhD thesis is to assess the feasibility and acceptability of early infant male circumcision (EIMC) as an HIV prevention intervention in Zimbabwe in order to inform roll out. Mathematical modelling estimates that circumcising 1.9 million Zimbabwean men aged 15-49 by 2015 could avert 42% of new HIV infections that would have otherwise occurred by 2025. Since 2009, Zimbabwe has provided voluntary medical male circumcision (VMMC) to over 300,000 adult and adolescent men. In order to ensure that the protective effect of male circumcision is sustained in the longer-term, Zimbabwe intends to roll out EIMC alongside adult MC, starting 2015. Although EIMC’s effects on HIV will take longer to realise, infant circumcision is easier, safer and cheaper than adult MC. Further, EIMC may more effectively prevent HIV acquisition as the procedure is carried out before the individual becomes sexually active, negating the risk associated with acquisition or transmission of HIV during the healing period. Since large-scale EIMC for HIV prevention, or indeed for other reasons, has never been practised in Zimbabwe or more widely in Southern Africa, there are concerns around its feasibility and acceptability. Clearly, acceptability of infant MC will have a bearing on uptake, roll out and subsequent effectiveness in preventing HIV. In Zimbabwe, there are also concerns about the feasibility of rolling out EIMC for HIV prevention within the context of existing health services, many of which are already overburdened and understaffed. The PhD research is in two phases. The first phase describes a systematic review and thematic synthesis I conducted to explore parental reasons for non-adoption of infant MC for HIV prevention in sub-Saharan Africa. Additionally, this phase qualitatively explored hypothetical acceptability of EIMC among parents and wider family as well as hypothetical feasibility and acceptability of EIMC among health-care workers. Findings from the first phase informed the design of a study to pilot EIMC roll out. The second phase was nested within a trial that assessed the feasibility, safety, acceptability and cost of rolling out EIMC using devices in Zimbabwe. It explored actual acceptability of EIMC among parents and wider family as well as actual feasibility and acceptability of EIMC among health-care workers. Findings from both phases informed recommendations for a demand generation intervention for EIMC which is currently being developed and will subsequently be tested for impact. Given that EIMC has been identified as a key HIV prevention intervention for sustaining the prevention gains anticipated through VMMC across sub-Saharan Africa, the findings of this research are likely to have broad implications for HIV prevention across the region.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.632003  DOI: Not available
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