Introduction Tanzania is one of the 14 priority countries in sub-Saharan Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention. In this study, we assessed the progress of VMMC by evaluating changes in the spatial structure of male circumcision (MC) prevalence and identifying age groups with low MC uptake.
Methods We use data from two waves of the Demographic and Health Survey (DHS) conducted in Tanzania in 2011–2012 and 2015–2016. MC incidence rate was estimated using a method developed to calculate incidence rates from two successive cross-sectional surveys. Continuous surface maps of MC prevalence were generated for both DHS waves and compared with identified areas with high MC prevalence changes and high density of uncircumcised males.
Results National MC prevalence in Tanzania increased from 73.5% in 2011–2012 to 80.0% in 2015–2016. The estimated national MC incidence rate was 4.6 circumcisions per 100 person-years (py). The lowest circumcision rate was observed in males aged 20–24 years, with 0.61 circumcisions per 100 py. An estimated 1 567 253 males aged 15–49 years residing in low-MC prevalence areas were uncircumcised in 2015–2016.
Conclusion Tanzania has shown substantial progress in the implementation of VMMC. However, extensive spatial variation of MC prevalence still exists in the country, with some areas having an MC prevalence <60%. Here, we identified locations where VMMC needs to be intensified to reach the ~1.5 million uncircumcised males age 15–49 living in these low-MC areas, particularly for men aged 20–34.
- geographic information systems
- cross-sectional survey
- public health
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Handling editor Sanni Yaya
Contributors HK and DFC contributed to the study and its design, conducted the statistical and spatial modelling analyses, and wrote the first draft of the paper. AB and FDWM contributed to the study conception and design, conduct of the statistical modelling analyses, interpretation of the results and writing of the manuscript. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The data that support the findings of this study are available from the Demographic and Health Surveys (http://www.measuredhs.com), but restrictions apply to the availability of these data, which were used under licence for the current study and so are not publicly available. However, data are however available from the authors on reasonable request and with the permission of Demographic and Health Surveys. Procedures and questionnaires for standard Demographic Health Surveys have been reviewed and approved by the ICF International Institutional Review Board (IRB). The ICF International IRB ensures that the survey complies with the US Department of Health and Human Services regulations for the protection of human subjects, while the host country IRB ensures that the survey complies with laws and norms of the nation (http://dhsprogram.com/What-We-Do/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm%23sthash.Ot3N7n5m.dpuf). We sought and were granted permission to use the core dataset for this analysis by Measure DHS.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository.
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