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PREDICTORS OF MEDICAL MALE CIRCUMCISION UPTAKE BY MEN AGED 25-39 YEARS IN NYANZA
Donath Emusu1, Kawango Agot2, Jonathan Grund3, Paul K Musingila4, Frankline Onchiri5, Edward Mboya2, Jacob Onyango2, Eunice Omanga2, Elijah Odoyo-June1, Boaz Otieno-Nyunya1
1US CDC, Nairobi, Kenya,2Impact Rsr and Development Org, Kisumu, Kenya,3CDC, Atlanta, GA, USA4US CDC, Kisumu, Kenya,5Seattle Children’s Rsr Inst, Seattle, WA, USA
Uptake of voluntary medical male circumcision (VMMC) as an intervention for the prevention of HIV is low among men aged ≥25 years in Nyanza region, Kenya. We evaluated the baseline prevalence and cofactors of VMMC among men 25-39 years who were targets of interventions to improve VMMC uptake.
As part of a cluster randomized controlled trial (cRCT) to evaluate tailored interventions to improve uptake of VMMC, we conducted a survey of men from the Luo, traditionally non-circumcising ethnic community who were aged 25-39 years and residing in non-contiguous administrative locations selected as cRCT sites. We determined their circumcision status, estimated VMMC prevalence and assessed predictors of being circumcised using univariate and multivariate Generalized Estimating Equations logistic regression to account for study design.
While 9,711 men were screened, 5,639 (58.1%) consented and were enrolled into cRCT. Of these 5,639 used for this analysis, 2,851 (50.6%) self-reported being circumcised. Uncircumcised men aged 25-39 years residing or planning to continue living in the study village for the next 9 months were included in the study. Circumcised men aged 39 years who were non-resident or planning to move away from the study village within 9 months after enrolment were excluded. Three-quarters of enrolled men consented to visual verification of circumcision status of whom 2,195 (52.0%) were confirmed fully or partially circumcised. The odds of being circumcised, as self-reported, were significantly higher for men with secondary school education (adjusted Odds Ratio (aOR)=2.15; 95% CI: 1.11-4.13, p =0.023), college (aOR=2.12; 95% CI: 1.12-4.00, p=0.021), and university (aOR=2.86; 95% CI: 1.53-5. 34, p=0.001) education compared to no education; for non-Christians (aOR=2.03; 95% CI: 1.28-3.21, p=0.003) compared to Christians; and for the employed (aOR=1.32; 95% CI: 1.09-1.59, p=0.004). The odds were lower for men with history of being divorced/separated/widowed (aOR=0.59; 95% CI: 0.41-0.85, p=0.005) compared to being single; and for men aged 35-39 years (aOR 0.83; 95% CI: 0.41-0.85, p=0.003) compared to men aged 25-29 years.
Among the Luo community in Nyanza region of Kenya, men aged 35-39 years with post-primary education, non-Christians and employed are more likely to be circumcised. VMMC providers seeking to improve uptake among men aged 25-34 years should target men who are or were married, the less educated and the unemployed.