Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling

Abstract

Background

Human immunodeficiency virus (HIV) remains the leading cause of years of life lost among adolescent boys in eastern and southern Africa. Medical male circumcision (MMC) is a cost-effective one-time intervention that can reduce the risk of heterosexual HIV acquisition in men by approximately 60%. Despite its importance in HIV prevention, the uptake of MMC remains suboptimal among adolescent boys. This study aimed to identify factors associated with low MMC uptake among adolescent boys in Tanzania.

Methods

This study was a secondary analysis of the 2016–17 Tanzania HIV Impact Survey. Descriptive statistics were used to summarize the participants’ characteristics. Unadjusted and adjusted multinomial logistic regression models were fitted to identify factors associated with low MMC uptake among adolescent boys.

Results

A total of 2605 older adolescents (15–19 years) and 1296 young adolescents (10–14 years) were analyzed. The MMC uptake rates among older and young adolescents were 56.5% and 45.1%, respectively. Lower MMC uptake was found among respondents in rural areas (adjusted relative risk ratio [aRRR] = 0.40, 95% CI: 0.28–0.57), in the traditionally non-circumcising zone (aRRR = 0.30, 95% CI: 0.23–0.41), participants with no formal education (aRRR = 0.32, 95% CI: 0.23–0.41), and those living in lower wealth quintile households (aRRR = 0.20, 95% CI: 0.11–0.36). Respondents who were not covered by health insurance (aRRR = 0.67, 95% CI: 0.48–0.94) and those who had no comprehensive HIV knowledge (aRRR = 0.55, 95% CI: 0.44–0.70) were also found to have lower uptake of MMC.

Conclusion

To achieve and maintain high MMC coverage, MMC interventions for HIV prevention should focus on uncircumcised adolescent boys who are rural residents, of lower socioeconomic status, and residing in traditionally non-circumcising communities. Furthermore, dissemination of HIV knowledge and increasing health insurance coverage may encourage more adolescent boys to undergo MMC.

Keywords:

• adolescent boys
• HIV prevention
• medical male circumcision
• Tanzania

Abbreviations

HIV, human immunodeficiency virus; MMC, medical male circumcision; MLRM, multinomial logistic regression model; RRR, relative risk ratio; THIS, Tanzania HIV impact survey; TMC, traditional male circumcision; WHO, World Health Organization; UNAIDS, Joint United Nations Programme on HIV and AIDS.

Data Sharing Statement

Datasets used in this study are available upon request from the PHIA website: https://phia-data.icap.columbia.edu/datasets?country_id=10.

Ethics Approval and Informed Consent

The 2016–17 THIS was approved by the National Institute for Medical Research (NIMR) and the Zanzibar Medical Research and Ethics Committee (ZAMREC). Adolescent boys aged 10-17 years provided informed verbal assent and those aged 18-19 years provided informed verbal consent.¹⁷ Permission to use the datasets for the current analyses was obtained from the Population-based HIV Impact Assessment (PHIA) website https://phia-data.icap.columbia.edu/ Participants’ confidentiality and privacy were secured. All methods applied in this study were in accordance with the standards and regulations of the Declaration of Helsinki.⁵⁴

Acknowledgments

Authors are thankful to the PHIA project for allowing us to access and use the 2016-17 THIS datasets. We extend our gratitude the US President’s Emergency Plan for AIDS Relief (PEPFER) through the US Centers for Disease Control and Prevention (CDC) for funding the PHIA project.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.