Abstract of the dissertation

Early infant male circumcision for HIV prevention in Uganda: determinants of uptake and future intentions; and exploration of health workers’ perspectives

by

Michael EdiauDoctor of Philosophy in Public Health (Global Health) San Diego State University 2022 University of California San Diego 2022

Professor Susan M. KieneBackground: World Health Organization (WHO) recommends early infant male circumcision (EIMC) for HIV prevention in countries with high HIV prevalence and low male circumcision (MC) coverage, like Uganda. This dissertation assessed the; effect of MC knowledge on EIMC (chapter 1) and theorized determinants of intention to circumcise male infants and associated moderators in central Uganda (chapter 2). It also explored health workers’ perspectives on EIMC in a traditionally non-circumcising community in northeastern Uganda (chapter 3). Methods: This was a cross-sectional survey of parents of male children aged 0–5 years from central Uganda (chapters 2 and 3). Multivariable logistic regression analysis was performed to determine correlates of male infant circumcision (chapter 2, n=1,831). The theory of planned behavior (TPB) predictors of intention to circumcise male children and potential moderators were assessed using PATH analyses (chapter 3, n=2,134). To explore health workers’ perspectives on EIMC (chapter 4), a qualitative descriptive study was conducted using in-depth interviews with health workers (n=26) in Soroti and Katakwi districts. Qualitative data were analyzed using thematic analysis. Results: The odds of having a circumcised male child were higher among parents who knew MC prevents HIV infection (aOR 1.77, 95% CI 1.57-1.98, p<0.001), circumcised fathers (aOR 1.87, 95% CI 1.68-2.08, p<0.001). TPB predictors of intention included attitude (Coeff=0.58, p=0.002) and PBC (Coeff=0.26, p=0.002). Gender and father’s circumcision status did not moderate any TPB relationship. Health workers who participated in EIMC welcomed it for its benefits and advantages, including being a simple procedure, fast wound health, and future HIV prevention. However, some health workers who had not participated in EIMC expressed concerns about EIMC, including the risk of injury and pain. EIMC facilitators included the provision of funding and health workers’ training on EIMC. Reported barriers included lack of funding and supplies as EIMC barriers since the provided support ended. Conclusion: Having knowledge of MC predicted male infant circumcision. Attitude and PBC towards EIMC predicted intention to circumcise male children. Donor funding availability facilitated EIMC, while its cessation was a barrier to EIMC delivery. EIMC programs should target knowledge, attitude, and behavioral control and ensure funding.