Voluntary Male Circumcision for HIV Prevention in Rural Non-Circumcising Provinces of Northern, Muchinga and Luapula, 2018–2020. A Cross Sectional Survey

Abstract

IntroductionWe describe the VMMC uptake across in Rural Non-circumcising provinces of Luapula, Northern and Muchinga 2018 to 2020. Method This was cross sectional analysis of routine programme data targeting males 10 years older (from October 2018 to April 2020), 15 years (from May 2020) and above VMMC was undertaken using both static and outreach activities. A multi-pronged strategy was adopted that included procurement of VMMC kits to supplement the government’s shortfall, training of VMMC providers (doctors, clinical officers and nurses) dedicated space for circumcision in each facility, logistics support ( fuel and allowances) for outreach programs, mapping of catchment areas for community mobilization and demand creation. All circumcisions performed were recorded in MOH VMMC registers. Data collected was verified by Provincial Health Office. Daily Situation Room (DSR) reports were used to monitor performance. Poor performing districts were followed up and challenges addressed to improve performance. ResultsA total of 2,130 focused outreach activities were carried out between 2018 and 2020 across the three provinces and 486,750 participants were reached. Of the 486,750 participants reached, 151, 428 were circumcised; 56136 (37%) from Northern, 49297 (33%) from Muchinga, and 45995 (30%) from Luapula. There was a three-fold increase in circumcision between 2018 and 2019 (14,746 circumcisions in 2018 vs 54,287 circumcisions in 2019) and a 14% increase from 2019 (38%) to 2020 (52%; 58,287 circumcisions). Most (76%) of the circumcision were done in the age group 15 to 29 years. HIV testing was undertaken among 6,319 participants giving a positivity rate of 2.4% (149). Improved results were associated with logistical support such as transport, VMMC commodity supplies, and increased dedicated VMMC providers. ConclusionHealth systems support including training, logistical support, dedicated space and supply of commodities assisted in increase of VMMC uptake in these rural non-traditional circumcision provinces. even amidst the outbreak of COVID19. Health systems strengthening and community outreach programmes are recommended for building health programs resilience in era of the COVID pandemic.