Male Circumcision Acceptability & Impact Study (MCAIS), Papua New Guinea

Date Commenced:
December 2007
Project Status
Completed
Expected Date of Completion:
Completed
Project Supporters

AusAID Australian Development Research Award (ADRA)

Currently recruiting
No
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About the Project

Project Collaborators: External

PNG Institute of Medical Research

Mt Hagen General Hospital, PNG

HOPE Worldwide, PNG

University of Queensland, Australia

The Burnet Institute, Melbourne

Male circumcision for HIV prevention among at-risk men and women in Papua New Guinea: Acceptability, epidemiological impact, cost effectiveness and options for implementation.

Rationale

A series of phase III clinical trials in Africa demonstrated the efficacy of male circumcision (MC) for the prevention of HIV infection in men and led WHO to recommend male circumcision for inclusion within comprehensive national prevention programs in high-prevalence settings in 2007. The potential role of MC for HIV prevention in countries experiencing lower prevalence HIV epidemics, such as Papua New Guinea (PNG) remains unclear.

Design & Method

The Male Circumcision Acceptability & Impact Study, PNG (MCAIS) was afour-year multi-disciplinary community-based research program to investigate the potential of male circumcision for HIV prevention in PNG. The study was conducted among general and at-risk populations at multiple sites, and had four principal components: qualitative research; mathematical modeling; health systems research; and longitudinal clinical cohort studies. A sub-study to investigate the notional acceptability of a vaginal microbicide surrogate for HIV prevention among women and men attending a sexual health clinic in Port Moresby was completed in 2010.

Benefits

Research findings were presented at a Joint National Policy Forum on Male Circumcision for HIV Prevention in PNG held in Port Moresby in November 2011 in order to translate research evidence into public health action. The Forum was jointly coordinated and funded by MCAIS and was co-chaired by the PNG National AIDS Council Secretariat (NACS) and the PNG Sexual Health Society (SHS). The Forum made three key recommendations: (1) the formation of a joint NDoH/NACS Policy Committee on Male Circumcision; (2) the establishment of an integrated Harm Reduction Program; and (3) that future policy on wide scale roll-out of MC for HIV prevention in PNG be informed bya combination of (a) data from MC intervention pilot programs and (b) formative research on the potential protective effect of other forms of penile cutting. The MCAIS group has been asked to take a lead role in these future research activities and will be leading these new activities from 2013 onwards.

Output

Journal Articles

1.    ‘If he cuts his skin he will not think of his wife’: Why women object to male circumcision to prevent HIV in a middle prevalence countryKelly A, Kupul M, Aeno H, Neo J, Naketrumb R, Fitzgerald L, Kaldor JM, Siba P, Vallely A.. Qual Health Res [E-pub ahead of print, Nov 2012].

2.    Health workers, health facilities and penile cutting in Papua New Guinea: Implications for Male Circumcision as an HIV prevention strategy. Tynan A, Vallely A, Kelly A, Kupul M, Law G, Milan J, Siba P, Kaldor J, Hill PS.PNG Med J[in press]

3.    Male circumcision for HIV prevention in Papua New Guinea:Summary of research evidence and recommendations for public health policy following a National Policy Forum. Vallely A, MacLaren D, Kaleva W, Millan J, Tommbe R, Marape W, Buchanan H, Amos A, Kelly A, Kupul M, Aeno H, Trowalle E, John L, Ryan C, Tynan A, Browne K, Hill PS, Gray R, Murray J, Wilson D, Law G, Siba P, McBride J, Farley T, Kaldor JM.PNG Med J [in press]

4.    More than just a cut: A qualitative study of penile practices and their relationship to masculinity, sexuality and contagion and their implications for HIV prevention in Papua New Guinea. Kelly A, KupulM, AenoH, NeoJ, NaketrumbR, FitzgeraldL, HillPS, Kaldor JM, SibaP, Vallely A. BMC International Health Human Rights 2012; 12(1):10

5.    “Now we are in a different time; various bad diseases have come.” Understanding men’s acceptability of male circumcision for HIV prevention in a moderate prevalence setting.Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, Siba P, Kaldor JM, Vallely A.BMC Pub Health 2012; 12: 67

6.    Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting. VallelyA, Fitzgerald L, Fiya V, Aeno H, Kelly A, Sauk J, Kupul M, NeoJ, MillanJ, NairS, SibaP, Kaldor JM. BMC Res Notes 2012; 5:613.

7.    Vasectomy as a proxy:  extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea. Tynan A, Vallely A, Kelly A, Law G, Milan J, Siba P, Kaldor J, Hill P.BMC Health Services Res2012;12(1): 299

8.    A typology of penile cutting in Papua New Guinea: results of a Modified Delphi study among sexual health clinicians.Hill PS, Tynan A, Law G, Millan J, Browne K, Sauk J, Kupul M, Kelly A, Siba P, Kaldor J, Vallely A. AIDS Care, 2012; 24(1):77-86

9.    The prevalence of sexually transmitted infections in Papua New Guinea: A systematic review and meta-analysis Vallely A, Page A, Dias S, Siba P, Lupiwa T, Law G, Millan J, Wilson D, Murray JM, Toole M, Kaldor JM. PLoS ONE 2010; 5(12): e15586. doi:10.1371/journal.pone.0015586

Reports

1.    The PNG HIV Model - Summary and Results: Explaining the past, describing the present, and forecasting the future of the HIV epidemic in PNG.Gray RT, Murray JM, Wilson DP, Vallely A, Kaldor J. The Kirby Institute, University of New South Wales, Sydney, Australia, August 2011

2.    Male circumcision for HIV prevention in Papua New Guinea: a summary of two research projects.Vallely A, MacLaren D on behalf of the Male Circumcision for HIV Prevention in Papua New Guinea Program. Papua New Guinea Institute of Medical Research: Port Moresby, 2011

Conference Presentations

1.     Sexually transmitted infections among sexual health clinic attendees in two provinces in Papua New Guinea: A longitudinal clinical cohort study. Simbiken CS, Ryan CE, Wapling J, Sauk JC, Allen J, Kaima P, Kombati Z, Law G, Murray J, Siba PM, Kaldor J, Vallely A. Poster presentation, International Union against Sexually Transmitted Infections (IUSTI) World Congress 2012. Melbourne Australia, October 2012.

2.     “Sympathy for my people”: Socio-cultural and individual determinants for motivation of sexual health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy in Papua New Guinea.Tynan A, Vallely A, Kelly A, Kupul M, Neo J, Naketrumb R, Aeno H, Law G, Milan J, Siba P, Kaldor JM, Hill P. Australasian HIV/AIDS Conference 2012. Melbourne, Australia, October 2012.

3.     Being circumspect about circumcision: penile cutting practices in Papua New Guinea and their implications for HIV prevention strategies.Tynan A, Hill P, Law G, Millan J, Kelly A, Browne K, Sauk J, Kupul M, Siba P, Kaldor J, Vallely A.In: International Conference in AIDS and STIs in Africa (ICASA). Addis Adaba, Ethiopia; 2011.

4.     Vasectomy as a proxy: Extrapolating Health System Lessons to Male Circumcision as an HIV Prevention Strategy in Papua New Guinea. Tynan A, Vallely A, Kelly A, Kupul M, Geita L, Law G, Milan J, Siba P, Kaldor J, Hill P. In: 23rd Australasian HIV/AIDS Conference. Canberra, Australia; 2011.

5.     The PNG HIV Model: Explaining the past, describing the present, and forecasting the future of the HIV epidemic in PNG. Gray RT, Murray JM, Vallely A, Lote N, Lupiwa T, Millan J, Daoni E, Kaldor J, Siba P, Wilson D: In: 23rd Australasian HIV/AIDS Conference. Canberra, Australia; 2011.

6.     Estimating the impact of male circumcision on the HIV epidemic in Papua New Guinea. Gray R, Murray J, Vallely A, Siba P, Kaldor J, Wilson D. PNG Sexual Health Society Meeting, Kimbe, Papua New Guinea, September 8th 2011.

7.     Community perspectives of implementing male circumcision for HIV prevention in PNG: implications for future service delivery. Vallely A, Tynan A, Kupul M, Aeno H, Kelly A, Neo J, Naketrumb R, Fiya V, Hill PS, Siba P, Kaldor J on behalf of the Male Circumcision Acceptability & Impact Study (MCAIS) Team.   In: 47th Annual Symposium of the Medical Society of Papua New Guinea. Kimbe, West New Britain; 2011.

8.     Acceptability of male circumcision for HIV prevention among men and women attending sexual health clinics in PNG. Vallely A, Kelly A, Kaima P, Sauk J, Mek A, Aeno H, Allan J, Naketrumb R, Fiya V, Neo J, Fitzgerald L, Siba P, Kaldor J on behalf of the Male Circumcision Acceptability & Impact Study (MCAIS) Team. In: 47th Annual Symposium of the Medical Society of Papua New Guinea. Kimbe, West New Britain; 2011.

9.     A Longitudinal Clinical Pilot Study Among Men and Women Attending A Sexual Health Clinic in Mt Hagen, Papua New Guinea. Vallely A, Kaima P, Neo J, Kombati Z, Toliman P, Ryan C, Law G, Kelly A, Millan J, Mek Tet al: In: Australasian HIV/AIDS Conference, Sydney, Australia; 2010.

10.   A typology of penile cutting in Papua New Guinea: results of a modified Delphi study among sexual health clinicians.Hill P, Tynan A, Law G, Millan J, Browne K, Sauk J, Kelly A, Kupul M, Aeno H, Siba Pet al: In: Australasian HIV/AIDS Conference, Sydney, Australia; 2010.

11.   Mapping penile cutting and insert practices in Papua New GuineaAeno H, Kelly A, Kupul M, Neo J, Naketrumb R, Fitzgerald L, Hill PS, Kaldor JM, Siba P, Vallely A:. In: Australasian HIV/AIDS Conference. Sydney, Australia; 2010.

12.   Vaginal microbicide acceptability in Papua New Guinea: results of a qualitative study among women and men attending a sexual health clinic in Port MoresbyVallely A, Aeno H, Fitzgerald L, Fiya V, Kelly A, Sauk J, Kupul M, Neo J, Millan J, Nair Set al:. In: Australasian HIV/AIDS Conference, Sydney, Australia; 2010.

13.   Intravaginal hygiene and menstrual practices: implications for HIV/STI prevention and future microbicide acceptability in Papua New GuineaSauk J, Fiya V, Aeno H, Kupul M, Kelly A, Neo J, Millan J, Fitzgerald L, Kaldor J, Siba Pet al:. In: Australasian HIV/AIDS Conference, Sydney, Australia; 2010

14.   Pleasure or pain: penile inserts amongst men in PNG. Kelly, A., Naketrumb R, Kupul M, Aeno H, Neo J, Vallely A, Fitzgerald L, Kaldor J, Siba P. Forty-Fifth Annual Symposium of the Medical Society of Papua New Guinea, Port Moresby, Papua New Guinea, 30th Aug-5th Sep 2009.

15.   Meanings of circumcision amongst non-traditionally circumcised men in Papua New Guinea.Kelly, A., Neo J, Kupul M, Naketrumb R, Aeno H, Vallely A, Fitzgerald L, Kaldor J, Siba P. Forty-Fifth Annual Symposium of the Medical Society of Papua New Guinea, Port Moresby, 30th Aug-5th Sep 2009.

16.   Women's views on circumcision as an HIV-prevention strategy in Papua New GuineaKupul, M., Kelly, A., Aeno, H, Neo, J., Naketrumb, R., Valley, A., Fitzgerald, L., Kaldor, J., Siba, P. Forty-Fifth Annual Symposium of the Medical Society of Papua New Guinea, Port Moresby, 30th Aug-5th Sep 2009.

Other Investigators

Andrew Vallely, Peter Siba, John Kaldor, Angela Kelly, Claire Ryan, John Murray, David Wilson, Richard Gray, Martha Kupul, Herick Aeno, Voletta Fiya, James Neo,

Richard Naketrumb, Greg Law, Petronia Kaima, Zure Kombati, Joyce Sauk, Joyce Allan, Pamela Toliman, Lisa Fitzgerald, Peter Hill, Anna Tynan, John Millan.

Project Members
image - 1339124418 Jk2
Professor and Program Head
Ph +61 (0)2 9385 0961
image - Andrewv New
Associate Professor
Ph +61 (0)2 9385 0900
image - 1343188801 David Wilson
Associate Professor and Program Head
Ph +61 (0)2 9385 0900
image - 1338434124 Richard Gray Sepph
Lecturer
Ph +61 (0)2 9385 0925
Project Research Area

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