Downs, J.A., Mwakisole, A.H., Chandika, A.B., et al. The Lancet (February 2017), pii: S0140-6736(16)32055-4, e-publication ahead of print, doi:10.1016/S0140-6736(16)32055-4.
This cluster-randomized trial in northwest Tanzania (June 2014–December 2015) examined whether educating village religious leaders about male circumcision (MC) could increase its uptake within their communities. The Ministry of Health (MOH) carried out MC outreach in 16 villages, and services were divided into 8 pairs. One village in each pair was randomly selected to receive either education for Christian church leaders on scientific, religious, and cultural aspects of MC (intervention) or standard MC outreach (control). Religious leaders in the intervention group received a one-day seminar taught by a pastor and a clinician from the MOH and participated in biweekly meetings with the study team throughout the circumcision campaign. In the intervention villages, 30,889 men (52.8% of all men) were circumcised, versus 25,434 men (29.5% of all men) in the control villages. The authors said that although this study took place in a specific region of Tanzania, their approach was to provide church leaders with knowledge and tools, leaving the leaders to promote MC in the most appropriate way for their communities. This approach could thus be applied generally. They concluded that working through religious leaders is an innovative way to promote healthy behaviors for HIV prevention and other clinical outcomes in a variety of settings.