MOPDE0104 - Poster Discussion
Service delivery trends in Kenya's voluntary medical male circumcision scale-up from 2008-2011
Presented by Zebedee Mwandi (Kenya).
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
Background: Three randomized controlled trials demonstrated a 60% protective effect of voluntary medical male circumcision (VMMC) on HIV acquisition in men from heterosexual sex. Kenya has adopted a national strategy to provide VMMC services to 80% of uncircumcised males aged 15-49 years.
Methods: Sites providing VMMC in Kenya as part of the President's Emergency Plan for AIDS Relief (PEPFAR) routinely report on program indicators. We performed a secondary analysis on VMMC data from 2008-2011 and disaggregated by age, cadre of provider, adverse events (AEs), service delivery type, and partner acceptance of HIV testing.
Results: From 2008-2011, 312,789 adolescent and adult males have been circumcised in 260 CDC-supported sites. The median age was 17 years (range 0-84 years), and 66% were between 15-24 years. Clinical officers performed 56% of VMMCs, nurses 42%, and medical officers 2% (p< 0.0001). The proportion of VMMCs done by nurses and clinical officers increased from 69% in 2008 to 99% in 2011 (p< 0.0001). In all, 32.7% of men returned for post-operative review within seven days. The prevalence of moderate and severe AEs for the 102,372 clients returning for follow-up was 2.26%. The trend of AEs among all cadres decreased in 2011with clinical officers and nurses both registering an AE rate of 1.4%, while medical officers registered 0%. VMMCs done in mobile settings have increased from 6% in 2009 to 12% in 2011 (p< 0.0001). In 2010, HIV testing for sexual partners of VMMC clients was launched, and 74% of partners of VMMC clients aged 15+ years accepted HIV testing.
Conclusions: Kenya's shift in cadre of VMMC provider is an effective and safe strategy to provide large-scale VMMC surgery. A better understanding of strategies to increase post-operative follow-up after VMMC surgery is needed. VMMC may be an innovative approach to provide HIV testing to sexual partners of VMMC clients.
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