Male circumcision provides partial protection against HIV acquisition in heterosexualmen. In 2010, Tanzania launched a National Strategy for scaling up male circumcision, whichaims to circumcise 2.8 million males by 2015. During a recent PEPFAR-funded campaign byJhpiego in Iringa region, over 10,000 males were circumcised in six weeks. In line with thenational strategy the target age for the campaign was 10-34 years, but 80% of clients were aged10-19 years. This is a cause for concern, as modelling studies suggest that the greatestpopulation-level benefit of circumcision on HIV incidence will be achieved by circumcising menin their 20s and 30s, when HIV incidence is highest.The goal of our proposed study is to increase uptake of circumcision among older men (age 20-34 years).
Our specific aims are to refine, implement and evaluate a strategy to increase theuptake of circumcision among males aged 20-34 years in Iringa and Tabora regions, Tanzania.The strategy is based on Information-Motivation-Behavioral Skills (IMB) theory. We willconduct a qualitative study to identify barriers and facilitating factors to uptake of malecircumcision services among males aged 20-34 years in Iringa and Tabora regions; use thesefindings to refine and pilot a targeted strategy to increase circumcision uptake in this age group;and evaluate the effectiveness of the intervention on the number and proportion of male clientsaged 20-34 through a cluster randomized controlled trial (RCT). The research will build uponand be conducted alongside Jhpiego's ongoing circumcision provision in Tanzania. For theRCT, sixteen facilities providing circumcision services and their surrounding communities willbe randomized to either the intervention group (those in which the targeted strategy will beimplemented) or the control group (providing the standard circumcision provision package).Data will be collected from each clinic for a 4 week period during the 2012 Tanzaniancircumcision season (June-August). The primary outcomes will be the proportion ofcircumcision clients who are aged 20-34 years, the mean weekly number of clients in this agegroup, and the cost per client of the intervention.The proposed operational research will provide timely evidence on whether a community-basedstrategy can provide a cost-effective method of increasing the proportion and number of malecircumcision clients aged 20-34 years in Tanzania. If successful, the resulting strategy can betranslated into routine and common practices throughout Tanzania and in other countries.

Public Health Relevance

Male circumcision provides partial protection against HIV acquisition, and circumcision services are being scaled-up across Eastern and Southern Africa. The most efficient strategy to reduce HIV infection is to attract men in their 20s and 30s (those at highest risk of HIV) to come for circumcision. Currently, about 4 in 5 male clients are aged under 20 years. We plan to undertake research to refine and implement a strategy to increase uptake of circumcision among older men in Tanzania.

National Institute of Health (NIH)
Coordinating Office of Global Health (COGH)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZGH1-SRC (99))
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National Institute for Medical Research
Dar Es Salaam
Tanzania U Rep
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