XIX International AIDS Conference


MOPDE01 Male Circumcision: Are We Making the Cut?
  Oral Poster Discussion Session : Track E
Venue: Session Room 8
Time: 23.07.2012, 13:00 - 14:00
Co-Chairs: Anita Asiimwe, Rwanda
Robert Bailey, United States
 
 

13:00
MOPDE0101
Rwanda's experience in scaling-up male medical circumcision


A. Asiimwe, Rwanda

13:05
MOPDE0103
Abstract
Powerpoint
Implementation of VMMC efficiency elements in four sub-Saharan countries: service delivery methods and provider attitudes
J. Bertrand1, D. Rech2, E. Njeuhmeli3, D. Castor3, S. Frade2, M. Loolpapit4, M. Machaku5, W. Mavhu6, L. Perry1
1Tulane School of Public Health and Tropical Medicine, Tulane SPHTM, New Orleans, United States, 2CHAPS, Johannesburg, South Africa, 3USAID, Washington, United States, 4FHI360/Kenya, Nairobi, Kenya, 5Jhpiego/Tanzania, Dar es Salaam, United Republic of Tanzania, 6ZAPP, Harare, Zimbabwe
J. Bertrand, United States

13:10
MOPDE0102
Abstract
Powerpoint
Determinants of VMMC provider burnout in four sub-Saharan countries
J. Bertrand1, D. Rech2, E. Njeuhmeli3, D. Castor3, S. Frade2, M. Loolpapit4, M. Machaku5, W. Mavhu6, L. Perry1
1Tulane SPHTM, Global Health Systems and Development, New Orleans, United States, 2CHAPS, Johannesburg, South Africa, 3USAID, Washington, United States, 4FHI360/Kenya, Nairobi, Kenya, 5Jhpiego/Tanzania, Dar es Salaam, United Republic of Tanzania, 6ZAPP, Harare, Zimbabwe
D. Rech, South Africa

13:15
MOPDE0104
Abstract
Service delivery trends in Kenya's voluntary medical male circumcision scale-up from 2008-2011
Z. Mwandi1, A. Ochieng2, J. Grund3, S. Mwalili1, D. Kimanga2, G. Otieno4, S. Ohaga5, P. Oyaro6, C. Mwangi7, N. Knight1, K. Chesang1, N. Bock3
1CDC Kenya, Nairobi, Kenya, 2National AIDS and STD Control Program, Ministry of Health, Nairobi, Kenya, 3Centers for Disease Control and Prevention, Atlanta, United States, 4Nyanza Reproductive Health Society, Kisumu, Kenya, 5Impact Research and Development Organisation, Kisumu, Kenya, 6Kenya Medical Research Institute, FACES Program, Nairobi, Kenya, 7Eastern Deanery AIDS Relief Program, Kisumu, Kenya
Z. Mwandi, Kenya

13:20
MOPDE0105
Abstract
Powerpoint
Male circumcision in Swaziland: demographics, behaviours and HIV prevalence
J.B. Reed1, M. Mirira2, J. Grund1, A. Nqeketo3, H. Ginindza3, D. Donnell4, R. Nkambule3, G. Bicego5, C. Ryan6, J. Justman7
1U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of HIV/AIDS, Atlanta, United States, 2USAID Swaziland, Mbabane, Swaziland, 3Ministry of Health - Swaziland, Mbabane, Swaziland, 4Fred Hutchinson Cancer Research Center, Seattle, United States, 5U.S. Centers for Disease Control and Prevention Swaziland, Mbabane, Swaziland, 6Office of the Global AIDS Coordinator, Washington, United States, 7ICAP at the Mailman School of Public Health at Columbia University, New York, United States
J. Reed, United States

13:25
MOPDE0106
Abstract
Powerpoint
A comparative analysis of two high-volume male medical circumcision (MMC) operational models with similar service delivery outcomes in different settings within Gauteng and KwaZulu-Natal provinces in South Africa: urban Centre for HIV/AIDS Prevention Stud
N. Soboil1, J. Cockburn1, D. Rech2, D. Taljaard2
1SACTWU, Worker Health Program, Cape Town, South Africa, 2CHAPS, Johannesburg, South Africa
N. Soboil, South Africa

13:30
MOPDE0107
Abstract
Powerpoint
We too are shareholders: why women must be meaningfully involved in the rollout of medical male circumcision in Africa
K. Agot, S. Ohaga, B. Ayieko, E. Omanga, M. Kabare
Impact Research & Development Organization, Kisumu, Kenya
K. Agot, Kenya

13:35
Moderated discussion



Powerpoints presentations
Implementation of VMMC efficiency elements in four sub-Saharan countries: service delivery methods and provider attitudes - Jane Bertrand

Determinants of VMMC provider burnout in four sub-Saharan countries - Dino Rech

Male circumcision in Swaziland: demographics, behaviours and HIV prevalence - Jason Bailey Reed

A comparative analysis of two high-volume male medical circumcision (MMC) operational models with similar service delivery outcomes in different settings within Gauteng and KwaZulu-Natal provinces in South Africa: urban Centre for HIV/AIDS Prevention Studies (CHAPS) versus rural-SACTWU Worker Health Program (SWHP) - Nikki Soboil

We too are shareholders: why women must be meaningfully involved in the rollout of medical male circumcision in Africa - Kawango Agot



Rapporteur report

Track E report by Benjamin Chi


Although voluntary medical male circumcision (VMMC) is considered an important component for combination HIV prevention, successful implementation requires numerous factors: political leadership, country ownership, resource deployment (including finances and human resources), and engagement of community stakeholders.

J. Bertrand reviewed results of the Systematic Monitoring of the Male Circumcision Scale-up (SYMMACS) study, an evaluation of VMMC services in 73 sites across Kenya, South Africa, Tanzania, and Zimbabwe. Wide variation was observed in 6 “efficiency elements” (surgical method, task-shifting, task-sharing, rotation of multiple bays, bundling of supplies and tools, use of electrocautery), emphasizing the need for ongoing site monitoring and tailored site interventions.  

In a follow-up SYMMACS analysis, D. Rech reported levels of occupational burnout (up to 70%) among VMMC providers. The rates appeared highest among providers who had worked in the programs longest and among those who had performed the most procedures.

Z. Mwandi provided updated figures for the Kenyan national program, which has performed VMMC in over 312,000 adolescent and adult men from 2008 to 2011. The greatest yearly increase in VMMC uptake was observed among 15-24 year olds. Although clinical officers and nurses now perform the vast majority of procedures, adverse events remained low at ~2% of cases.  

J. Reed presented the VMMC component of the Swaziland HIV Incidence Measurement Survey (SHIMS), a nationally representative household survey conducted between December 2010 and July 2011. Reported circumcision among male respondents was 16%, double that of 2007 estimates (8%). Circumcised men were more likely to have accessed HIV testing and prevention services and less likely to be infected (14% vs. 24% prevalence).

N. Soboil and colleagues compared two models for high-volume VMMC provision in South Africa: a traditional “fixed” facility vs. a “roving” team that converted sites into temporary surgical units. The relative advantages and disadvantages of each were compared, including program cost, patient follow-up, and ongoing capacity. The investigators conclude that a combination approach – taking the strengths of each approach – could yield the best results.

K. Agot and colleagues conducted a systematic review around women’s engagement in VMMC services. Notable findings included the lack of risk compensation behaviors among circumcised men; the early resumption of sexual activity before wound-healing; and prevalent misconceptions about the effectiveness of VMMC on HIV transmission and acquisition. The authors advocate for greater female involvement in all phases of VMMC education, recruitment, and follow-up, including the integration of couples HIV testing at this important entry point.

These abstracts provide a broad overview of the many successes and challenges of VMMC scale-up in sub-Saharan Africa. As programs rapidly expand, innovative strategies are needed to generate demand within communities, while ensuring the availability of safe and effective services at the level of the health system. 




   

    The organizers reserve the right to amend the programme.


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