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Evaluation of factors influencing uptake of voluntary medical male circumcision amongst males in the pivot age group (15-29 years) in East Central Uganda

Title
Evaluation of factors influencing uptake of voluntary medical male circumcision amongst males in the pivot age group (15-29 years) in East Central Uganda
Presenter
Keith Baleeta
Authors
K. Baleeta * (1), A. Muhwezi (1), R. Iriso (1), L. McGough (2), F. Twebaze (1), M. Namwabira (1), S. Khasaka (1), D. Mwehire (3), M. Mbonye (1), B. Nsangi Kintu (4), M. Etukoit (5), B. Tibengana (5), E. Kayongo (6), D. Byonanebye (7,8), J. Wasswa (1)
Institutions
(1) University Research Co., LLC, USAID RHITES EC Project, Jinja, Uganda, (2) University Research Co., LLC, Maryland, United States, (3) USAID Uganda, Kampala, Uganda, (4) Baylor Uganda, Hoima, Uganda, (5) The AIDS Support Organisation (TASO), Kampala, Uganda, (6) John Hopkins University-Centre for Communication Programs, USAID SBC Project, Kampala, Uganda, (7) University of New South Wales, Sydney, Australia, (8) Makerere University, School of Public Health, Kampala, Uganda

BACKGROUND: The World Health Organization recommends Voluntary Medical Male Circumcision(VMMC) as a key HIV prevention approach. Mathematical modeling suggests that circumcising 80% of males aged 15'49 in sub-Saharan Africa could avert 3.36 million HIV infections by 2025. With respect to Uganda, the focal demographic for HIV prevention was 15'29 years. However, little is documented in Uganda about factors influencing VMMC uptake in this pivot age group. We sought to determine the level of uptake, and factors influencing uptake of VMMC amongst males aged 15-29 years in East-Central Uganda.
METHODS: This was a cross-sectional study. Eligible participants were males aged 15-29 years mobilized for VMMC by the thirty health facilities accredited for VMMC in East-Central Uganda. Following ethical approval and participant informed consent, data was collected in September 2020. Participants were randomly sampled from a line-list of mobilized individuals using systematic sampling. Participants were categorized as circumcised or not circumcised. Logistic regression was used to identify factors associated with the uptake of VMMC.
RESULTS: Overall 1,230 males aged 15-29 years were enrolled in the study of whom 937 (76%) were circumcised. Motivators to VMMC uptake included: Parental encouragement: [aOR = 1.76 ,95%CI:1.26-2.44];knowledge about benefits: reduces risk of STIs and HIV [aOR = 2.04,95% CI:1.13-3.68], reduces risk of cervical cancer in female partners [aOR =1.51,95% CI:1.09-2.10];knowledge about where VMMC services are offered [aOR = 3.18,95% CI:1.99-5.09]; health worker confidentiality [aOR= 2.89,95% CI:1.63-5.10];affordable transport costs [aOR=1.57,95% CI:1.06-2.31].
Barriers to VMMC uptake included: female partners involvement in decision making to take up VMMC [aOR = 0.37,95% CI: 0.26-0.52];Fear of complications [aOR=0.67,95% CI:0.49-0.93];Fear of pain [aOR=0.46,95%CI:0.30-0.70].
CONCLUSIONS: The study showed that an estimated 76% of males aged 15-29 years in East-Central Uganda have been circumcised. The factors associated with VMMC uptake included: parental encouragement; belief in health worker confidentiality; affordable transport costs; knowledge about where VMMC is offered, and VMMC benefits i.e. decreases risk of HIV, STI's and cervical cancer for female partners. Barriers included: fear of pain and post VMMC complications; and involvement of female partners in decision making to take up VMMC. We recommend that mobilization messaging be refined to address these findings.