Voluntary Medical Male Circumcision: Translating Research into the Rapid Expansion of Services in Kenya, 2008–2011

Abstract

Zebedee Mwandi and colleagues discuss Kenya's scale-up of voluntary medical male circumcision services, highlighting government leadership, a clear implementation strategy, and program flexibility and innovation as keys to Kenya's success.

Programme science research on medical male circumcision scale-up in sub-Saharan Africa

“…In Orange Farm, the MOVE approach allowed a team of five nurses and one circumciser to perform up to 50 MCs per day. w3 Similar results were achieved in Zimbabwe,25 and in Kenya, the MOVE strategy has facilitated the provision of MMC to approximately 290 000 men between 2008–2011 22. The observed rate of MOVE complications in Orange Farm was 1.8%; however, one-third of patients did not return for follow-up, so this complication rate cannot be fully assessed.…”

“…Peaks of demand were observed during school holidays, requiring a Rapid Results Initiative, a short-term intensification of services which enlisted up to 700 providers to meet the demand 22. With respect to programme efficiency, clients who fail to come for scheduled MMC appointments can affect programme productivity, a problem which can be partially mitigated by use of cell phone text message reminders for surgery and follow-up visits (N Kighoma pc).…”

“…Given the relatively modest rates of postoperative follow-up reported in service programmes (65–80%), 22 w8 failure to return for ring removal could be problematic and methods of encouraging men to come for scheduled visits need additional assessment. With respect to cost, the Shang ring currently costs ∼$15.00 and the PrePex $20.00; although costs are likely to decline with wider adoption, the overall cost saving compared with conventional surgery (∼$45–65) may be substantial 19…”

“…However, as of the end of 2010, fewer than 600 000 MMCs, representing less than 3% of the 20 million goal, had been achieved in the region 20. Only Kenya, with approximately 290 000 MMCs is on track to achieving its target with ∼61.5% coverage 22. Manifestly, substantial programmatic changes are needed.…”

Male circumcision programmes in Kenya: lessons from the Kenya AIDS Indicator Survey 2007

“…a Each man's response was weighted to take its sampling probability into account and to adjust for the nonresponse rate. 9,17 In Nyanza province, implementation began in October 2008 and, by the end of September 2011, approximately 210 000 men had been circumcised, which is 50% of the target for 2014 (Athanasius Ochieng, personal communication). The use of outreach and mobile units involving dedicated teams has been recommended as the best approach for reaching men aged between 15 and 49 years in the first phase of the national strategy.…”