Uptake of Medical Male Circumcision Among Men With Sexually Transmitted Infections

NCT ID: NCT04677374

Last Updated: 2023-09-14

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2242 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-01

Study Completion Date

2022-08-30

Brief Summary

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The intervention includes provision of transport reimbursement for men who will undergo voluntary medical male circumcision (VMMC), intensified health education by a VMMC mobilizer and a male and female VMMC champion and use of a cell phone short messaging service (SMS) and/or telephonic tracing to remind clients of their VMMC appointment (the RITe intervention). The investigators will assess the uptake of VMMC, and acceptability, appropriateness and feasibility of the RITe intervention among uncircumcised men attending a Sexually Transmitted Infection (STI) clinic and health care workers.

This intervention was initially designed to include escorting men interested in circumcision from the STI clinic to a VMMC clinic co-located in the same facility. However, the VMMC clinic space was repurposed to a COVID-19 isolation unit therefore clinic escorts were excluded. In Lieu of clinic escorts, participants will be linked to the nearest health facility of choice where VMMC services are provided by the VMMC mobilizer.

The purpose of the study is to evaluate the impact of using transport reimbursement, intensified health education and SMS/telephonic tracing in increasing the uptake of voluntary medical male circumcision at this clinic.

Detailed Description

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This study will be a pragmatic, pre- and post-interventional quasi-experimental study combined with a prospective observational study design. The study will have pre-implementation and implementation phases and use a concurrent exploratory mixed method approach.

The study will evaluate the effect of multi-faceted intervention on the uptake of VMMC. The intervention includes use of transport reimbursement for men who will undergo VMMC, Intensified health education by VMMC champions and women and use of SMS/telephonic Tracing to remind clients of their VMMC appointment (the RITe intervention).

The intervention will be conducted in a sequential and incremental manner called implementation blocks. After collecting data from the standard of care period, the first implementation block will be for intensified health education. The next block will combine intensified health education with SMS/telephonic tracing. The last block will combine intensified health education with SMS/telephonic tracing and transport reimbursements. This approach will allow the investigator to compare the effectiveness of different combinations of the strategies in the intervention without necessarily randomizing participants. The sample size for each block is expected to be at least 80 uncircumcised men with STIs. The investigators anticipate that each block may last about 4-12 weeks (to allow the interventions to mature) with one week of no intervention between interventions as a wash out period. However, sample size may be higher if more uncircumcised men present within the minimum 4-week intervention period.

The study population will be men attending the Bwaila STI clinic in Lilongwe Malawi. The study will enroll a minimum of 320 men to depict an uptake rate of circumcision of about 28% (national average including traditional circumcision) among uncircumcised men. However, for each intervention to settle, the investigator will implement each intervention for at least 4 weeks.

Data on uptake of VMMC will be collected through a standardize data collection form in conjunction with routine data from the STI clinic electronic medical registry. Data on acceptability, appropriateness and feasibility will be collected through surveys, interviews and focus group discussions. The investigators will conduct about 280 surveys for acceptability, appropriateness and feasibility with men selected randomly through the implementation period (70 men per intervention block). About 20 in-depth interviews with healthcare workers equally divided by intervention block will be conducted to assess acceptability, appropriateness and feasibility. Finally, the investigators will conduct four focus group discussions with men through the study period to assess acceptability, appropriateness and feasibility of the RITe strategy.

Conditions

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HIV Infections Sexually Transmitted Infections

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

The intervention will be rolled-out in the implementation phase in a sequential and incremental manner called implementation blocks. Implementation blocks will be as follows: block 1: Intensified health education (I); block 2: Intensified health education and SMS/telephonic Tracing (IT) and finally, Block 3: Intensified health education, SMS/telephonic tracing and transport Reimbursement (RITe)
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Standard of care

Participants in this arm will be offered Standard of Care (SOC) referral process for voluntary medical male circumcision (VMMC) services

Group Type PLACEBO_COMPARATOR

Standard of care

Intervention Type OTHER

Standard of care referral approach which is a brief health talk conducted once every morning by a VMMC mobilizer.

Block 1 (intensified health education)

Participants in this arm will be offered intensified health education

Group Type EXPERIMENTAL

Intensified Health Education

Intervention Type BEHAVIORAL

More detailed health talk conducted during each group health talk session by the VMMC mobilizer and champions describing VMMC, its benefits and how to access the service and testimonies from men who have successfully undergone VMMC

Block 2 (intensified health education and SMS/telephonic tracing)

Participants in this arm will be offered intensified health education and SMS/telephonic tracing

Group Type EXPERIMENTAL

SMS/telephonic Tracing

Intervention Type BEHAVIORAL

SMS tracing to remind participants of VMMC appointments

Block 3 (intensified health education, SMS/telephonic tracing and transport reimbursement)

Participants in this arm will be offered intensified health education, SMS/telephonic tracing and transport reimbursement

Group Type EXPERIMENTAL

Transportation Reimbursement

Intervention Type BEHAVIORAL

Transportation reimbursement to offset the cost of transportation for VMMC appointments

Interventions

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Standard of care

Standard of care referral approach which is a brief health talk conducted once every morning by a VMMC mobilizer.

Intervention Type OTHER

Intensified Health Education

More detailed health talk conducted during each group health talk session by the VMMC mobilizer and champions describing VMMC, its benefits and how to access the service and testimonies from men who have successfully undergone VMMC

Intervention Type BEHAVIORAL

SMS/telephonic Tracing

SMS tracing to remind participants of VMMC appointments

Intervention Type BEHAVIORAL

Transportation Reimbursement

Transportation reimbursement to offset the cost of transportation for VMMC appointments

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Male
* 18 years or older
* Seeking STI care at the Bwaila STI clinic
* Not circumcised
* Healthcare workers at Bwaila STI and VMMC clinic

Exclusion Criteria

* \< 18 years of age
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

Yes

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

Fogarty International Center of the National Institute of Health

NIH

Sponsor Role collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mitch Matoga, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

UNC

Locations

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UNC Project-Malawi (Bwaila District Hospital)

Lilongwe, , Malawi

Site Status

Countries

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Malawi

References

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Matoga MM, Kudowa E, Chikuni J, Tsidya M, Tseka J, Ndalama B, Bonongwe N, Mathiya E, Jere E, Yatina D, Kamtambe B, Kapito M, Hosseinipour MC, Chasela CS, Jewett S. Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: a mixed methods study. medRxiv [Preprint]. 2024 Apr 4:2024.03.27.24304985. doi: 10.1101/2024.03.27.24304985.

Reference Type DERIVED
PMID: 38633812 (View on PubMed)

Matoga MM, Kudowa E, Ndalama B, Bonongwe N, Mathiya E, Jere E, Kamtambe B, Chagomerana M, Chasela C, Jewett S, Hosseinipour MC. Effectiveness of an intervention to increase uptake of voluntary medical male circumcision among men with sexually transmitted infections in Malawi: a preinterventional and postinterventional study. BMJ Open. 2023 Oct 3;13(10):e072855. doi: 10.1136/bmjopen-2023-072855.

Reference Type DERIVED
PMID: 37788927 (View on PubMed)

Matoga MM, Hosseinipour MC, Jewett S, Chasela C. Uptake of voluntary medical male circumcision among men with sexually transmitted infections in Lilongwe, Malawi: a protocol for a pre-interventional and post-interventional study. BMJ Open. 2022 Jan 18;12(1):e057507. doi: 10.1136/bmjopen-2021-057507.

Reference Type DERIVED
PMID: 35042709 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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D43TW010060

Identifier Type: NIH

Identifier Source: secondary_id

View Link

19-2559

Identifier Type: -

Identifier Source: org_study_id

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