Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

Mahler, Hally; Kileo, Baldwin; Curran, Kelly; Plotkin, Marya; Adamu, Tigistu; Hellar, Augustino; Koshuma, Sifuni; Nyabenda, Simeon; Machaku, Michael; Lukobo-Durrell, Mainza; Castor, Delivette; Njeuhmeli, Emmanuel; Fimbo, Bennett

doi:10.1371/journal.pmed.1001131

Cited by 57 publications

(54 citation statements)

References 4 publications

(4 reference statements)

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“…Adherence at each visit was plotted over the first 12 months after ART initiation; during this period, adherence was expected to be documented at 13 visits (2,4,8,12,16,20,24,28,32,36,40,44, 48 weeks post ART initiation). Random effects logistic regression was used to examine the association between CD4 count at initiation and sub-optimal adherence at each visit.…”

Section: Discussionmentioning

confidence: 99%

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

et al. 2018

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“…SYMMACS results contribute to the scant literature on VMMC service delivery: on human resource issues [11], [12], disposable versus reusable instruments [13], the safety of task-shifting [14], and descriptions of programs implementing efficiency elements in KE [15], RSA [16], TZ [17], and Uganda [18]. In addition, they have prompted policy debate and programmatic action in all four countries where they have been presented in in-country diseemination conferences, scientific meetings, workshops, and other venues.…”

Section: Discussionmentioning

confidence: 95%

Systematic Monitoring of Voluntary Medical Male Circumcision Scale-Up: Adoption of Efficiency Elements in Kenya, South Africa, Tanzania, and Zimbabwe

Bertrand¹,

Rech

Aduda³

et al. 2014

PLoS ONE

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BackgroundSYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up, tracked the implementation and adoption of six elements of surgical efficiency— use of multiple surgical beds, pre-bundled kits, task shifting, task sharing, forceps-guided surgical method, and electrocautery—as standards of surgical efficiency in Kenya, South Africa, Tanzania, and Zimbabwe.Methods and FindingsThis multi-country study used two-staged sampling. The first stage sampled VMMC sites: 73 in 2011, 122 in 2012. The second stage involved sampling providers (358 in 2011, 591 in 2012) and VMMC procedures for observation (594 in 2011, 1034 in 2012). The number of VMMC sites increased significantly between 2011 and 2012; marked seasonal variation occurred in peak periods for VMMC. Countries adopted between three and five of the six elements; forceps-guided surgery was the only element adopted by all countries. Kenya and Tanzania routinely practiced task-shifting. South Africa and Zimbabwe used pre-bundled kits with disposable instruments and electrocautery. South Africa, Tanzania, and Zimbabwe routinely employed multiple surgical bays.ConclusionsSYMMACS is the first study to provide data on the implementation of VMMC programs and adoption of elements of surgical efficiency. Findings have contributed to policy change on task-shifting in Zimbabwe, a review of the monitoring system for adverse events in South Africa, an increased use of commercially bundled VMMC kits in Tanzania, and policy dialogue on improving VMMC service delivery in Kenya. This article serves as an overview for five other articles following this supplement.

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“…In contrast, fear of pain during and after the procedure was not perceived as a major barrier to VMMC in some traditionally circumcising communities [41] [42], although it was so in other settings [2] [43]. Even in a recent medical male circumcision campaign, only a very small proportion (less than 1%) of adverse events was reported [44]. Therefore, the misconception about complications associated with VMMC in the current study could be associated with inadequate knowledge about VMMC, previous experiences with complications commonly encountered with traditional circumcision, or misinformation from other people.…”

Section: Fear Of Pain and Bleedingmentioning

confidence: 99%

Overcoming Barriers to Uptake of Voluntary Medical Male Circumcision in a Traditionally Circumcising Community in Machinga District, Malawi

Masese¹,

Chimango²,

Mbirimtengerenji³

2017

WJA

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Introduction: Voluntary medical male circumcision (VMMC) reduces chances of contracting HIV during heterosexual intercourse in males, and risk of cervical cancer in their female sexual partners. However, its uptake among traditionally circumcising communities, where male circumcision carries a cultural significance, has not been studied. Previous research has focused on barriers to uptake of VMMC in non-circumcising communities. This study was conducted to determine socio-cultural barriers to VMMC uptake in order to identify culture-sensitive and evidence-based interventions to increase its uptake. Methodology: This exploratory mixed methods cross-sectional study generated quantitative data from 262 randomly sampled sexually active men; and qualitative data through four focus-group discussions with 58 purposely selected male participants and 10 key informants. Results: The study established that only 6.3% (n = 15) of those circumcised (90.8%, n = 238) were circumcised in clinical setting. Limited access to VMMC services, cost, pain, being attended to by female providers and cultural influences were the major hindrances to uptake of VMMC. Conclusion: Although there is a paradigm shift of preference from traditional male circumcision to VMMC in this community, its uptake is low. The study recommends that besides introducing mobile VMMC services, the Ministry of Health should collaborate with traditional circumcisers and local leaders to provide gender-and-culture-sensitive safer medical male circumcision services.

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Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

Abstract: Hally Mahler and colleagues evaluate a six-week voluntary medical male circumcision campaign in Iringa province of Tanzania, providing a model for matching supply with demand for services and showing that high-volume circumcisions can be performed without compromising client safety.

Cited by 57 publications

References 4 publications

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Systematic Monitoring of Voluntary Medical Male Circumcision Scale-Up: Adoption of Efficiency Elements in Kenya, South Africa, Tanzania, and Zimbabwe

Overcoming Barriers to Uptake of Voluntary Medical Male Circumcision in a Traditionally Circumcising Community in Machinga District, Malawi

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