The US President’s Emergency Plan for AIDS Relief’s (PEPFAR’s) guidelines highlight voluntary medical male circumcision (VMMC) as one of the core biomedical prevention intervention activities for HIV alongside condom use, HIV testing and counseling, diagnosis and treatment of sexually transmitted infections, and ARV‐based prevention. During MCHIP’s implementation, leaders from five international organizations1 launched a strategic framework for action that guided and ensured streamlined efforts to circumcise 20.3 million men in 14 countries in eastern and southern Africa by 2016 in order to avert 3.4 million future HIV infections. MCHIP focused on scaling up services across countries to work toward this ambitious goal. Through its technical experts and global presence, MCHIP made an impact on increasing access to VMMC services while ensuring the services offered were of the highest quality.
Key Activities
- Supported the highly visible VMMC Advocacy Satellite Meeting at the 19th International AIDS Conference in Washington, D.C., garnering much media attention as African leaders advocated for the scale up of VMMC in priority countries.
- Provided high-level technical assistance to Tanzania, Lesotho, Mozambique and Malawi using a combination of core and field funding mechanisms.
- Produced the PEPFAR VMMC Best Practices Guide, which is focused on implementation activities at the site-service level, and provides the necessary steps to implement programs at scale. Also produced the VMMC Best Practices video, a global resource for individual providers, implementers and program managers working in VMMC. (Both are available on the Clearinghouse on Male Circumcision for HIV Prevention.)
- Published with Jhpiego staff free access and peer reviewed journal PLoS articles on various subject matter related to VMMC.
- Attended a series of meetings examining the future possibilities of VMMC devices in service provision. MCHIP worked with the PEPFAR technical working group to strategize and plan for the approval of one or more VMMC device(s) and the implementation/repercussions of using said devices to improve the scale up of VMMC in 14 priority countries.
Results
Tanzania: MCHIP’s VMMC program in Iringa, Tanzania (in collaboration with the regional medical office of Iringa) achieved an increase in the prevalence of VMMC in the region from 29% in 2009 to 50% in 2012. As a result, Tanzanian’s Iringa region has become one of the few VMMC programs coming close to achieving the 80% coverage target. The region is headed toward a significant reduction in new HIV infections in the next 10 years, coupled with tremendous cost saving that otherwise would be spend on antiretroviral treatment and care in the region.
Malawi: Through MCHIP core and field office support, Malawi’s Ministry of Health conducted its first VMMC campaign between October and November 2011, in Mulanje district, southern region. The four-week campaign registered a total of 4,516 men to receive VMMC, accounting for 225% of the circumcisions performed in the country in the two years preceding the campaign (less than a 1,000 circumcisions per year). HIV testing uptake was high, with 4,237 (97.4%) clients accepting testing. Of these, 2.1% clients tested HIV positive. Adverse events were monitored at three different intervals: on the day of the procedure; at 48 hours post-operation; and at one week post-operation.
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1 The World Health Organization, the Joint United Nations Programme on HIV/AIDS, PEPFAR, the Bill & Melinda Gates Foundation, and the World Bank, in consultation with national Ministries of Health.