Assessment of factors associated with low uptake of voluntary Medical male circomcision for HIV prevention among adult married men in Kibogora district hospital catchment area

Abstract

Background: While prevalence of voluntary medical male circoncision (VMMC) in Rwanda is 30% at national level, its uptake level is still unknown in Kibogora DH area and a noted low demand among married men. This study aimed to determine the uptake level of VMMC in this rural area, and assessed possible reasons behind its low demand among older married men in various contexts for evidence based decision making of its improvement.

Methods: A health facilities-based cross sectional study with qualitative and quantitative components targeting adult married men aged from 20-59 years old was conducted in 7 health centers of Kibogora DH, in Nyamasheke district, western province of country from March to July 2019. The sample was done of 483 participants including 446 married men presented at antenatal care service at HFs, 16 healthcare providers and 21 community health workers. In deph interviewed using structured open ended questionnaire; and seven Focus Group discussions were conducted. The univariate, bivariate and multivariate full and reduced logistic regression analysis were performed for quantitative data using stata MP13. The Chi square, the Pearson’s R test and Wald chi-square test-based p-values equal to or less than 0.05 , Wald test and associated p-value (chi-square = 9.4 , p<0.05), the Lilelihood Ratio Chi Square test (LR Chi2 = 10.46, p-value <0.05) and McFadden’s Pseudo R-Square were used for testing for significance and colinearity.The odds ratio (OR) was computed and results set at 95% Confidence Interval and the P value <0.05.The thematic analysis around main thematic area comprising barriers ,cultures and possible solutions for qualitative data and presented using text, with some quotations noted in order to reproduce keys messages obtained during FGDs. Results were presents into tables, figures and texts.

Results: The study found that only 43,5% of adult married men aged 20-59 years old have undergone VMMC, and found it a bit high at Nyamasheke (10.54%) and lowest at Ruheru HC (2.47%).The profession [OR=299;PV=0.000], having information on VMMC[OR=2.53;PV=0.043],having the information on Protection against HIV by VMMC[OR=2.27;PV=0.022 ] and distance from to achieve VMMC services[OR=1.78;PV=0.040 ] were found statistically associated low uptake of VMMC in Kibogora DH in logistic regression model analysis.Thematic analysis underlined the misconceptions, inadéquate community sensitization and the limited quality of VMMC service delivery at health facility level. The Cultural beliefs and practices, personal and societal beliefs and perceptions including family conflicts were noted, as well as the breach of Culture, and misconceptions. The financial accessibility and limited involvement of religious and local authorities were also outlined by this study.

Conclusion: A signifiant proportion of adult married men have not opted for circumcision in the area of Kibogora DH. Most of identified factors and barriers for its low uptake may be handled through conjugated efforts of community, Health staff, local and religious authorities at all levels. There is a need to improve VMMC services delivery, outreaches and campaigns, by offering VMMC services for free, trainings and reflesher’s activities also to be reinforced for health staff and community health workers. This should contribute in increasing of VMMC among married men in Kibogora DH cachment area.