{"doi":"10.1136/bmjopen-2023-072855","title":"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","abstract":"OBJECTIVE: To evaluate the effect a multistrategy demand-creation and linkage intervention on voluntary medical male circumcision (VMMC) uptake, time to VMMC and predictors of VMMC uptake among men with sexually transmitted infections (STIs). DESIGN: Pragmatic preinterventional and postinterventional quasi-experimental study combined with a prospective observational design. SETTING: A public and specialised STI clinic in Lilongwe, Malawi. POPULATION: Uncircumcised men who presented to the STI clinic. METHODS AND INTERVENTION: The intervention consisted of transport reimbursement ('R'), intensified health education ('I') and short-messaging services/telephonic tracing ('Te'), abbreviated (RITe). A preintervention phase was conducted at baseline while RITe was rolled-out in the intervention phase in a sequential manner called implementation blocks: 'I' only-block 1; 'I+Te'-block 2 and RITe-block 3. MAIN OUTCOME MEASURES: Primary: VMMC uptake and time to VMMC for the full intervention and for each block. Secondary: predictors of VMMC uptake. RESULTS: A total of 2230 uncircumcised men presented to the STI clinic. The mean age was 29 years (SD±9), 58% were married/cohabiting, HIV prevalence was 6.4% and 43% had urethral discharge. Compared with standard of care (8/514, 1.6%), uptake increased by 100% during the intervention period (55/1716, 3.2%) (p=0.048). 'I' (25/731, 113%, p=0.044) and RITe (17/477, 125%, p=0.044) significantly increased VMMC uptake. The median time to VMMC was shorter during the intervention period (6 days, IQR: 0, 13) compared with standard of care (15 days, IQR: 9, 18). There was no significant incremental effect on VMMC uptake and time to VMMC between blocks. Men with genital warts were 18 times more likely to receive VMMC (adjusted relative risk=18.74, 95% CI: 2.041 to 172.453). CONCLUSIONS: Our intervention addressing barriers to VMMC improved VMMC uptake and time to VMMC among uncircumcised men with STIs, an important subpopulation for VMMC prioritisation. TRIAL REGISTRATION NUMBER: NCT04677374.","journal":"BMJ Open","year":2023,"id":338863,"datarank":0.44350645644281594,"base_score":2.8903717578961645,"endowment":2.8903717578961645,"self_citation_contribution":0.4335557636844247,"citation_network_contribution":0.009950692758391203,"self_endowment_contribution":0.4335557636844247,"citer_contribution":0.009950692758391203,"corpus_percentile":null,"corpus_rank":null,"citation_count":17,"citer_count":15,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.947,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04677374"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":964425,"name":"Evaristar Kudowa","orcid":null,"position":1,"is_corresponding":false},{"id":445725,"name":"Beatrice Ndalama","orcid":"0000-0003-3735-2950","position":2,"is_corresponding":false},{"id":445726,"name":"Naomi Bonongwe","orcid":"0000-0001-7180-993X","position":3,"is_corresponding":false},{"id":1071849,"name":"Esther Mathiya","orcid":"0000-0001-6929-9168","position":4,"is_corresponding":false},{"id":445727,"name":"Edward Jere","orcid":"0000-0002-0019-7793","position":5,"is_corresponding":false},{"id":1072421,"name":"Blessings Kamtambe","orcid":null,"position":6,"is_corresponding":false},{"id":597211,"name":"Maganizo Chagomerana","orcid":"0000-0003-4231-4553","position":7,"is_corresponding":false},{"id":546828,"name":"Charles Chasela","orcid":"0000-0001-8362-5986","position":8,"is_corresponding":false},{"id":980994,"name":"Sara Jewett","orcid":null,"position":9,"is_corresponding":false},{"id":312050,"name":"Mina C. Hosseinipour","orcid":"0000-0003-2174-313X","position":10,"is_corresponding":false},{"id":445724,"name":"Mitch Matoga","orcid":"0000-0002-6542-8193","position":0,"is_corresponding":true}],"reference_count":47,"raw_metadata":null,"created_at":"2026-07-19T01:10:40.496978Z","pmid":"37788927","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}