Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

Mahler, Hally; Searle, Sarah C.; Plotkin, Marya; Kulindwa, Yusuph; Greenberg, Seth N.; Mlanga, Erick; Njeuhmeli, Emmanuel; Lija, Gissenje

doi:10.9745/ghsp-d-15-00151

Cited by 18 publications

(16 citation statements)

References 11 publications

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“…This strategy has already been employed in sub-Saharan Africa: from 2010 to 2014, South Africa allocated provincial resources for VMMC based on population size and epidemiology, which included HIV and MC prevalence [34,49]. In Tanzania, starting in 2012, geographic information systems were an effective tool for prioritizing VMMC needs in underserved rural communities [50]. This level of geographical precision, however, is not widespread; the WHO and UNAIDS emphasize that most countries lack sufficiently robust data to prioritize provinces or districts according to the potential impact and cost-effectiveness of MC [36].…”

Section: Discussionmentioning

confidence: 99%

Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa

Cork

Wilson

Perkins

et al. 2020

BMC Med

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Background: HIV remains the largest cause of disease burden among men and women of reproductive age in sub-Saharan Africa. Voluntary medical male circumcision (VMMC) reduces the risk of female-to-male transmission of HIV by 50-60%. The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries for VMMC campaigns and set a coverage goal of 80% for men ages 15-49. From 2008 to 2017, over 18 million VMMCs were reported in priority countries. Nonetheless, relatively little is known about local variation in male circumcision (MC) prevalence. Methods: We analyzed geo-located MC prevalence data from 109 household surveys using a Bayesian geostatistical modeling framework to estimate adult MC prevalence and the number of circumcised and uncircumcised men aged 15-49 in 38 countries in sub-Saharan Africa at a 5 × 5-km resolution and among first administrative level (typically provinces or states) and second administrative level (typically districts or counties) units. Results: We found striking within-country and between-country variation in MC prevalence; most (12 of 14) priority countries had more than a twofold difference between their first administrative level units with the highest and lowest estimated prevalence in 2017. Although estimated national MC prevalence increased in all priority countries with the onset of VMMC campaigns, seven priority countries contained both subnational areas where estimated MC prevalence increased and areas where estimated MC prevalence decreased after the initiation of VMMC campaigns. In 2017, only three priority countries (Ethiopia, Kenya, and Tanzania) were likely to have reached the MC coverage target of 80% at the national level, and no priority country was likely to have reached this goal in all subnational areas.

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Section: Discussionmentioning

confidence: 99%

Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa

Cork

Wilson

Perkins

et al. 2020

BMC Med

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“…The programmatic VMMC implementation started in 2009 in Njombe but in 2011 in Tabora [15]. By the midpoint of study implementation, Njombe region was nearing 80% VMMC coverage [29,30], whereas Tabora region was still at a lower level of coverage. The regional VMMC targets for Njombe and Tabora regions for the period of 2014–2017 were 74 333 and 212 751, respectively [10].…”

Section: Discussionmentioning

confidence: 99%

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

Wambura

Mahler

Grund

et al. 2017

Aids

Self Cite

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Objective:We evaluated a demand-creation intervention to increase voluntary medical male circumcision (VMMC) uptake among men aged 20–34 years in Tanzania, to maximise short-term impact on HIV incidence.Methods:A cluster randomized controlled trial stratified by region was conducted in 20 outreach sites in Njombe and Tabora regions. The sites were randomized 1 : 1 to receive either a demand-creation intervention package in addition to standard VMMC outreach, or standard VMMC outreach alone. The intervention package included enhanced public address messages, peer promotion by recently circumcised men, facility setup to increase privacy, and engagement of female partners in demand creation. The primary outcome was the proportion of VMMC clients aged 20–34 years.Findings:Overall, 6251 and 3968 VMMC clients were enrolled in intervention and control clusters, respectively. The proportion of clients aged 20–34 years was slightly greater in the intervention than control arm [17.7 vs. 13.0%; prevalence ratio = 1.36; 95% confidence intervals (CI):0.9–2.0]. In Njombe region, the proportion of clients aged 20–34 years was similar between arms but a significant two-fold difference was seen in Tabora region (P value for effect modification = 0.006). The mean number of men aged 20–34 years (mean difference per cluster = 97; 95% CI:40–154), and of all ages (mean difference per cluster = 227, 95% CI:33–420) were greater in the intervention than control arm.Conclusion:The intervention was associated with a significant increase in the proportion of clients aged 20–34 years in Tabora but not in Njombe. The intervention may be sensitive to regional factors in VMMC programme scale-up, including saturation.

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“…Modelling investigations likewise find age to be a beneficial, and in some cases particularly cost-effective 17, 18 , basis for market segmentation 19, 20 . Geographic segmentation is similarly common 13, 17– 19, 21 , and through modern mapping technology can offer novel applications 21, 22 .…”

Section: Resultsmentioning

confidence: 99%

The impact of market segmentation and social marketing on uptake of preventive programmes: the example of voluntary medical male circumcision. A literature review

Gomez¹,

Loar

Kramer³

2018

Gates Open Res

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Background: The business world has long recognized the power of defining discrete audiences within a target population. However, market segmentation’s full potential has not been applied to the public health context. While some broad elements of market segmentation (e.g., age, geography) are considered, a nuanced look at behavioural and psychographic segmentation, which could greatly enhance the possibility of lasting behaviour change, is often missing. Segmentation, and the associated mindset which acknowledges the multi-dimensional differences between people, allows service providers, implementers, policymakers, and government officials to target initiatives and lead to a greater likelihood of lasting behavioural change. This paper investigates what segmentation is, how it has been applied to voluntary medical male circumcision (VMMC), how it can be applied in development, and the challenges in both measuring and adopting segmentation as part of program design. Methods: We performed a detailed search of peer-reviewed literature using PubMed, ProQuest, ScienceDirect, Google Scholar, and the abstract directories of the International AIDS Society (IAS) published between January 2015 and September 2018. We also accessed articles from business databases such as the Harvard Business Review. Results: Results from a VMMC-focused intervention that successfully designed and delivered segmentation-based programs in two countries demonstrated that it is possible to adapt private sector approaches. However, within the sector of global development that is most familiar with segmentation, these efforts rarely go beyond basic demographic segments. Conclusions: Existing published material tends not to measure the impact of segmentation itself, but the impact of the intervention to which segmentation was applied, which makes it challenging for the development sector to invest in the approach without evidence that it works. Nonetheless, the experiences of segmentation and demand creation for VMMC do highlight the opportunity for better integrating this approach in HIV prevention and in global development and measurement initiatives.

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Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

Cited by 18 publications

References 11 publications

Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa

Mapping male circumcision for HIV prevention efforts in sub-Saharan Africa

Increasing voluntary medical male circumcision uptake among adult men in Tanzania

The impact of market segmentation and social marketing on uptake of preventive programmes: the example of voluntary medical male circumcision. A literature review

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