Uganda has experienced cases of tetanus in the safe male circumcision (SMC) program for HIV prevention. Gulu district begun implementation of tetanus toxoid (TT) vaccination of men prior to SMC in 2015. However, there is concern that the introduction of the vaccine in SMC may lead to reduced uptake of circumcision. This study aimed to assess the level and factors associated with acceptability of TT vaccine by adult men prior to SMC in Gulu district, Uganda.
This was a cross sectional study conducted from May to June 2017. A total of 685 uncircumcised men aged 18 years and above were interviewed using semi-structured questionnaires. Key informant interviews were conducted with 10 health workers and 2 district focal persons for immunization and HIV. Quantitative data analysis was done using STATA version 13. Qualitative data were analyzed using thematic content analysis.
Two thirds (66.1%) and 52.1% of respondents accepted TT vaccine for SMC and expressed willingness to get circumcised respectively. Good overall knowledge of tetanus and TT vaccination stood at 80.2% while only 11.3% knew the recommended vaccine doses. Factors significantly associated with acceptability of TT vaccine were: good overall knowledge of tetanus and TT vaccination (AOR: 2.05, 95% CI: 1.29-2.94), positive vaccine perception (AOR: 0.45, 95% CI: 0.24-0.82), TT vaccination community outreaches (AOR: 1.78, 95% CI: 1.05-2.99), ever received TT vaccination (AOR: 2.64, 95% CI: 1.76-3.97) and rural residence (AOR: 1.93, 95% CI: 1.14-3.29). Implementation challenges were: losses to follow up, limited funds, vaccine stock outs, lack of awareness on benefits of TT vaccination among community members and health workers.
Acceptability of TT vaccine prior to SMC was moderately high and willingness to get circumcised was 52.1%. The factors significantly associated with acceptability of TT vaccine before circumcision included good knowledge about tetanus and TT vaccine, positive vaccine perception, TT vaccination community outreaches, rural residence and ever received TT vaccine. The district health office and key implementing partners of SMC need to (1) Develop strategies for community sensitization on TT vaccination of men, (2) Conduct in service training and supervision of health workers on new policy changes, (3) Scale up SMC and strengthen community education on it’s benefits, and (4) Target use of community based approaches of vaccine delivery to improve accessibility and uptake.