BACKGROUND:This study aimed to document the clinical practices and attitudes of health care providers in South Africa and Zimbabwe on male circumcision for human immunodeficiency virus (HIV) prevention. METHODS:We conducted national surveys of physicians and nurses in both countries in 2008-2009 (N = 1444). Data on male circumcision for HIV prevention were analyzed; outcomes were patient counseling, provision of services, and desire for training. We used multivariable logistic regression to examine associations between these outcomes and clinician, practice, and attitudinal variables. RESULTS:Overall, 57% of clinicians reported counseling male patients on male circumcision, 17% were offering services (49% referrals), and 61% desired training. In the multivariable analyses, provision of services was more common in South Africa (P ≤ 0.001) but desire for training higher in Zimbabwe (P ≤ 0.01). Provision of services was highest among physicians (P ≤ 0.01) and in hospital settings (P ≤ 0.001). However, nurses had greater desire for training (P ≤ 0.05) as did younger clinicians (P ≤ 0.001). Clinicians in rural and clinic settings were just as likely to express training interest. Clinician attitudes that patients would be upset due to cultural beliefs and would increase risky behaviors were associated with less counseling and service provision (P ≤ 0.05). CONCLUSIONS:Many clinicians in South Africa and Zimbabwe showed willingness to integrate new HIV prevention evidence into practice and to become trained to offer the procedure to patients. Results suggest that both countries should consider involving nurses in male circumcision for HIV prevention, including those in rural areas, and should help clinicians to address cultural concerns.

译文

背景:本研究旨在记录南非和津巴布韦的医疗服务提供者对男性包皮环切术预防人类免疫缺陷病毒(HIV)的临床实践和态度。
方法:我们在2008-2009年对这两个国家的医师和护士进行了全国调查(N = 1444)。分析了男性包皮环切术预防艾滋病的数据;结果是患者咨询,服务提供和培训需求。我们使用多元逻辑回归分析了这些结果与临床医生,实践和态度变量之间的关联。
结果:总体而言,有57%的临床医生报告了对男性包皮环切术进行男性咨询的患者,有17%的患者提供服务(49%的转诊),以及61%的期望培训。在多变量分析中,服务的提供在南非更为普遍(P≤0.001),但在津巴布韦需要更高的培训(P≤0.01)。在医生中(P≤0.01)和在医院环境中(P≤0.001)提供的服务最高。但是,护士对培训的渴望更大(P≤0.05),而年轻的临床医生也是如此(P≤0.001)。农村和诊所环境中的临床医生也很可能表达出培训兴趣。临床医生认为患者会因文化信仰而感到不高兴,并会增加危险行为,这与较少的咨询和服务提供有关(P≤0.05)。
结论:南非和津巴布韦的许多临床医生都表示愿意将新的艾滋病毒预防证据纳入实践,并愿意接受培训以向患者提供该程序。结果表明,两国都应考虑让护士参加男性包皮环切术以预防艾滋病毒,包括在农村地区,并应帮助临床医生解决文化问题。

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