{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:07:54Z","timestamp":1740146874317,"version":"3.37.3"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["U2G GH000073 and U2G GH000419"],"award-info":[{"award-number":["U2G GH000073 and U2G GH000419"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Voluntary medical male circumcision (VMMC) uptake has been slow in some countries, including Botswana. To inform demand creation efforts, we examined sociodemographic characteristics and referral procedures associated with VMMC uptake in the Botswana Combination Prevention Project (BCPP) and examined the effectiveness of referral of men to MC services from HIV testing venues.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>BCPP was a community-randomized trial evaluating the impact of a combination HIV prevention package which included VMMC on community HIV incidence. We conducted a sub-analysis of VMMC uptake in intervention communities.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>During the initial VMMC campaign in 15 intervention communities, baseline male circumcision (MC) status was assessed among men eligible for HIV testing. Uncircumcised male community residents aged 16\u201349 years with negative\/unknown HIV status were mobilized and linked to study VMMC services. Outcomes included MC baseline status and uptake through study services. Univariate and multivariate logistic regressions were performed to identify factors associated with MC uptake.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 12,864 men eligible for testing, 50% (n = 6,448) were already circumcised. Among the uncircumcised men (n = 6,416), 10% (n = 635) underwent MC. Of the 5,071 men identified as eligible for MC through HIV testing services, 78% declined referral and less than 1% of those were circumcised. Of those accepting referral (n = 1,107), 16% were circumcised. Younger (16\u201324 years) (aOR: 1.51; 95%CI:1.22,1.85), unemployed men (aOR:1.34; 95%CI: 1.06,1.69), and those undergoing HIV testing at mobile venues (aOR: 1.88; 95%CI: 1.53,2.31) were more likely to get circumcised. Fear of pain was the most prevalent (27%) reason given for not being circumcised.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Younger, unemployed men seeking HIV testing at mobile sites in Botswana were more likely to get VMMC. Addressing unique barriers for employed and older men may be necessary. Given the simplicity of VMMC as an intervention, the HIV testing programs offer a platform for identifying uncircumcised men and offering information and encouragement to access services.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0269178","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T18:02:42Z","timestamp":1655316162000},"page":"e0269178","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Male circumcision uptake during the Botswana Combination Prevention Project"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1142-6114","authenticated-orcid":true,"given":"Tafireyi","family":"Marukutira","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faith","family":"Ussery","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etienne","family":"Kadima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa A.","family":"Mills","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Moore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Block","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pam","family":"Bachanas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracey","family":"Schissler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roselyn","family":"Mosha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onneile","family":"Komotere","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thebeyame","family":"Diswai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conrad","family":"Ntsuape","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Refeletswe","family":"Lebelonyane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Bock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"pone.0269178.ref001","unstructured":"UNAIDS. 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AIDS Behav"},{"issue":"3","key":"pone.0269178.ref024","doi-asserted-by":"crossref","first-page":"e0149892","DOI":"10.1371\/journal.pone.0149892","article-title":"Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review","volume":"11","author":"MR Kaufman","year":"2016","journal-title":"PLoS One"},{"issue":"2","key":"pone.0269178.ref025","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1521\/aeap.2019.31.2.136","article-title":"Immediate motivators to seeking voluntary medical male circumcision among HIV-negative adults men in an urban setting in Botswana","volume":"31","author":"PL Spees","year":"2019","journal-title":"AIDS Education and Prevention"},{"issue":"6","key":"pone.0269178.ref026","doi-asserted-by":"crossref","first-page":"e422","DOI":"10.1016\/S2352-3018(20)30103-X","article-title":"Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie\/BCPP): a cluster-randomised trial","volume":"7","author":"KE Wirth","year":"2020","journal-title":"The Lancet HIV"},{"issue":"2","key":"pone.0269178.ref027","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2989\/16085906.2014.943253","article-title":"Barriers and facilitators to the uptake of voluntary medical male circumcision (VMMC) among adolescent boys in KwaZulu-Natal, South Africa","volume":"13","author":"G George","year":"2014","journal-title":"Afr J AIDS Res"},{"key":"pone.0269178.ref028","article-title":"Voluntary Medical Male Circumcision to Prevent HIV: Modelling Age Prioritization in Namibia","author":"P Stegman","year":"2019","journal-title":"AIDS Behav"},{"issue":"11","key":"pone.0269178.ref029","doi-asserted-by":"crossref","first-page":"e0225076","DOI":"10.1371\/journal.pone.0225076","article-title":"Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project","volume":"14","author":"MG Alwano","year":"2019","journal-title":"PLoS One"},{"issue":"4","key":"pone.0269178.ref030","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s10461-019-02408-9","article-title":"Cost of Community-Based HIV Testing Activities to Reach Saturation in Botswana","volume":"23","author":"A Lasry","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0269178.ref031","unstructured":"WHO. 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