Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.

<h4>Introduction</h4>Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevale...

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Autores principales: Elijah Odoyo-June, Stephanie Davis, Nandi Owuor, Catey Laube, Jonesmus Wambua, Paul Musingila, Peter W Young, Appolonia Aoko, Kawango Agot, Rachael Joseph, Zebedee Mwandi, Vincent Ojiambo, Todd Lucas, Carlos Toledo, Ambrose Wanyonyi
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spelling oai:doaj.org-article:46cfbaf241604303a05e56356115cfd32021-12-02T20:06:58ZPrevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.1932-620310.1371/journal.pone.0254140https://doaj.org/article/46cfbaf241604303a05e56356115cfd32021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254140https://doaj.org/toc/1932-6203<h4>Introduction</h4>Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevalence of male circumcision (MC) in the subsequent years. Results of initial DMPPT2 modeling included implausible MC prevalence estimates, of up to 100%, for age bands whose sustained high uptake of VMMC pointed to unmet needs. Therefore, we conducted a cross-sectional survey among adolescents and men aged 10-29 years to determine the population level MC prevalence, guide target setting for achieving the goal of 80% MC prevalence and for validating DMPPT2 modelled estimates.<h4>Methods</h4>Beginning July to September 2019, a total of 3,569 adolescents and men aged 10-29 years from households in Siaya, Kisumu, Homa Bay and Migori Counties were interviewed and examined to establish the proportion already circumcised medically or non-medically. We measured agreement between self-reported and physically verified circumcision status and computed circumcision prevalence by age band and County. All statistical were test done at 5% level of significance.<h4>Results</h4>The observed MC prevalence for 15-29-year-old men was above 75% in all four counties; Homa Bay 75.6% (95% CI [69.0-81.2]), Kisumu 77.9% (95% CI [73.1-82.1]), Siaya 80.3% (95% CI [73.7-85.5]), and Migori 85.3% (95% CI [75.3-91.7]) but were 0.9-12.4% lower than DMPPT2-modelled estimates. For young adolescents 10-14 years, the observed prevalence ranged from 55.3% (95% CI [40.2-69.5]) in Migori to 74.9% (95% CI [68.8-80.2]) in Siaya and were 25.1-32.9% lower than DMMPT 2 estimates. Nearly all respondents (95.5%) consented to physical verification of their circumcision status with an agreement rate of 99.2% between self-reported and physically verified MC status (kappa agreement p-value<0.0001).<h4>Conclusion</h4>This survey revealed overestimation of MC prevalence from DMPPT2-model compared to the observed population MC prevalence and provided new reference data for setting realistic program targets and re-calibrating inputs into DMPPT2. Periodic population-based MC prevalence surveys, especially for established programs, can help reconcile inconsistencies between VMMC program uptake data and modeled MC prevalence estimates which are based on the number of procedures reported in the program annually.Elijah Odoyo-JuneStephanie DavisNandi OwuorCatey LaubeJonesmus WambuaPaul MusingilaPeter W YoungAppolonia AokoKawango AgotRachael JosephZebedee MwandiVincent OjiamboTodd LucasCarlos ToledoAmbrose WanyonyiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254140 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Elijah Odoyo-June
Stephanie Davis
Nandi Owuor
Catey Laube
Jonesmus Wambua
Paul Musingila
Peter W Young
Appolonia Aoko
Kawango Agot
Rachael Joseph
Zebedee Mwandi
Vincent Ojiambo
Todd Lucas
Carlos Toledo
Ambrose Wanyonyi
Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.
description <h4>Introduction</h4>Kenya started implementing voluntary medical male circumcision (VMMC) for HIV prevention in 2008 and adopted the use of decision makers program planning tool version 2 (DMPPT2) in 2016, to model the impact of circumcisions performed annually on the population prevalence of male circumcision (MC) in the subsequent years. Results of initial DMPPT2 modeling included implausible MC prevalence estimates, of up to 100%, for age bands whose sustained high uptake of VMMC pointed to unmet needs. Therefore, we conducted a cross-sectional survey among adolescents and men aged 10-29 years to determine the population level MC prevalence, guide target setting for achieving the goal of 80% MC prevalence and for validating DMPPT2 modelled estimates.<h4>Methods</h4>Beginning July to September 2019, a total of 3,569 adolescents and men aged 10-29 years from households in Siaya, Kisumu, Homa Bay and Migori Counties were interviewed and examined to establish the proportion already circumcised medically or non-medically. We measured agreement between self-reported and physically verified circumcision status and computed circumcision prevalence by age band and County. All statistical were test done at 5% level of significance.<h4>Results</h4>The observed MC prevalence for 15-29-year-old men was above 75% in all four counties; Homa Bay 75.6% (95% CI [69.0-81.2]), Kisumu 77.9% (95% CI [73.1-82.1]), Siaya 80.3% (95% CI [73.7-85.5]), and Migori 85.3% (95% CI [75.3-91.7]) but were 0.9-12.4% lower than DMPPT2-modelled estimates. For young adolescents 10-14 years, the observed prevalence ranged from 55.3% (95% CI [40.2-69.5]) in Migori to 74.9% (95% CI [68.8-80.2]) in Siaya and were 25.1-32.9% lower than DMMPT 2 estimates. Nearly all respondents (95.5%) consented to physical verification of their circumcision status with an agreement rate of 99.2% between self-reported and physically verified MC status (kappa agreement p-value<0.0001).<h4>Conclusion</h4>This survey revealed overestimation of MC prevalence from DMPPT2-model compared to the observed population MC prevalence and provided new reference data for setting realistic program targets and re-calibrating inputs into DMPPT2. Periodic population-based MC prevalence surveys, especially for established programs, can help reconcile inconsistencies between VMMC program uptake data and modeled MC prevalence estimates which are based on the number of procedures reported in the program annually.
format article
author Elijah Odoyo-June
Stephanie Davis
Nandi Owuor
Catey Laube
Jonesmus Wambua
Paul Musingila
Peter W Young
Appolonia Aoko
Kawango Agot
Rachael Joseph
Zebedee Mwandi
Vincent Ojiambo
Todd Lucas
Carlos Toledo
Ambrose Wanyonyi
author_facet Elijah Odoyo-June
Stephanie Davis
Nandi Owuor
Catey Laube
Jonesmus Wambua
Paul Musingila
Peter W Young
Appolonia Aoko
Kawango Agot
Rachael Joseph
Zebedee Mwandi
Vincent Ojiambo
Todd Lucas
Carlos Toledo
Ambrose Wanyonyi
author_sort Elijah Odoyo-June
title Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.
title_short Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.
title_full Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.
title_fullStr Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.
title_full_unstemmed Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.
title_sort prevalence of male circumcision in four culturally non-circumcising counties in western kenya after 10 years of program implementation from 2008 to 2019.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/46cfbaf241604303a05e56356115cfd3
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