{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:05:37Z","timestamp":1791889537792,"version":"4.3.4"},"reference-count":53,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T00:00:00Z","timestamp":1696204800000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NIH","award":["D43 TW009340"],"award-info":[{"award-number":["D43 TW009340"]}]},{"name":"NIH","award":["D43 TW009774-06"],"award-info":[{"award-number":["D43 TW009774-06"]}]},{"name":"NIH","award":["D43 TW010060"],"award-info":[{"award-number":["D43 TW010060"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,9,3]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"\n Objective<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Pragmatic preinterventional and postinterventional quasi-experimental study combined with a prospective observational design.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n A public and specialised STI clinic in Lilongwe, Malawi.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n Uncircumcised men who presented to the STI clinic.<\/jats:p>\n <\/jats:sec>\n \n Methods and intervention<\/jats:title>\n The intervention consisted of transport reimbursement (\u2018R\u2019), intensified health education (\u2018I\u2019) and short-messaging services\/telephonic tracing (\u2018Te\u2019), 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: \u2018I\u2019 only\u2014block 1; \u2018I+Te\u2019\u2014block 2 and RITe\u2014block 3.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Primary: VMMC uptake and time to VMMC for the full intervention and for each block. Secondary: predictors of VMMC uptake.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 2230 uncircumcised men presented to the STI clinic. The mean age was 29 years (SD\u00b19), 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). \u2018I\u2019 (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\u2009days, 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%\u2009CI: 2.041 to 172.453).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Our intervention addressing barriers to VMMC improved VMMC uptake and time to VMMC among uncircumcised men with STIs, an important subpopulation for VMMC prioritisation.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT04677374<\/jats:ext-link>.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072855","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T13:46:41Z","timestamp":1696340801000},"page":"e072855","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"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"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04677374","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04677374","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6542-8193","authenticated-orcid":false,"given":"Mitch M","family":"Matoga","sequence":"first","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"},{"name":"Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaristar","family":"Kudowa","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ndalama","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Bonongwe","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Mathiya","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Jere","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blessings","family":"Kamtambe","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maganizo","family":"Chagomerana","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Chasela","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6658-2061","authenticated-orcid":false,"given":"Sara","family":"Jewett","sequence":"additional","affiliation":[{"name":"Public Health, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina C","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,3]]},"reference":[{"key":"2025101812545392000_13.10.e072855.1","unstructured":"UNAIDS . On the Fast-Track to end AIDS. 2016-2021 Strategy. Geneva, Switzerland: UNAIDS and WHO, 2021."},{"key":"2025101812545392000_13.10.e072855.2","unstructured":"UNAIDS & World Health Organisation (WHO) . UNAIDS & World Health Organisation (WHO). Voluntary medical male circumcision: Progress Report. Geneva, Switzerland, 2021."},{"key":"2025101812545392000_13.10.e072855.3","unstructured":"National AIDS Commission . National VMMC Communication Strategy 2020-2025. Lilongwe, Malawi: National AIDS Commission, 2019."},{"key":"2025101812545392000_13.10.e072855.4","unstructured":"Malawi Ministry of Health . Integrated HIV Program Report October - December 2020. Lilongwe, Malawi: Ministry of Health, 2021."},{"key":"2025101812545392000_13.10.e072855.5","unstructured":"Mfutso Bengo J , Chalulu K , Jobiba Chinkhumba F , et al . Situation analysis of male circumcision in Malawi. Blantyre. 2010."},{"key":"2025101812545392000_13.10.e072855.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11979-z","article-title":"Key challenges to voluntary medical male circumcision uptake in traditionally circumcising settings of Machinga district in Malawi","volume":"21","author":"Masese","year":"2021","journal-title":"BMC Public Health"},{"key":"2025101812545392000_13.10.e072855.7","doi-asserted-by":"crossref","first-page":"40","DOI":"10.4236\/wja.2017.71005","article-title":"Overcoming barriers to uptake of voluntary medical male circumcision in a traditionally circumcising community in Machinga district","volume":"07","author":"Masese","year":"2017","journal-title":"WJA"},{"key":"2025101812545392000_13.10.e072855.8","first-page":"72","article-title":"Should female health providers be involved in medical male circumcision? narratives of newly circumcised men in Malawi","volume":"25","author":"Umar","year":"2013","journal-title":"Malawi Med J"},{"key":"2025101812545392000_13.10.e072855.9","doi-asserted-by":"crossref","unstructured":"Mhagama P , Makono P , Tsitsi C , et al . 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