Geospatial assessment of the voluntary medical male circumcision programme in Tanzania, 2011–2016

IntroductionTanzania is one of the 14 priority countries in sub-Saharan Africa scaling up voluntary medical male circumcision (VMMC) for HIV prevention. In this study, we assessed the progress of VMMC by evaluating changes in the spatial structure of male circumcision (MC) prevalence and identifying age groups with low MC uptake.MethodsWe use data from two waves of the Demographic and Health Survey (DHS) conducted in Tanzania in 2011–2012 and 2015–2016. MC incidence rate was estimated using a method developed to calculate incidence rates from two successive cross-sectional surveys. Continuous surface maps of MC prevalence were generated for both DHS waves and compared with identified areas with high MC prevalence changes and high density of uncircumcised males.ResultsNational MC prevalence in Tanzania increased from 73.5% in 2011–2012 to 80.0% in 2015–2016. The estimated national MC incidence rate was 4.6 circumcisions per 100 person-years (py). The lowest circumcision rate was observed in males aged 20–24 years, with 0.61 circumcisions per 100 py. An estimated 1 567 253 males aged 15–49 years residing in low-MC prevalence areas were uncircumcised in 2015–2016.ConclusionTanzania has shown substantial progress in the implementation of VMMC. However, extensive spatial variation of MC prevalence still exists in the country, with some areas having an MC prevalence <60%. Here, we identified locations where VMMC needs to be intensified to reach the ~1.5 million uncircumcised males age 15–49 living in these low-MC areas, particularly for men aged 20–34.

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Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up

International Journal of STD & AIDS ◽

10.1177/0956462418787896 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1432-1443 ◽

Cited By ~ 6

Author(s):

Jason B Reed ◽

Rupa R Patel ◽

Rachel Baggaley

Keyword(s):

Male Circumcision ◽

Scale Up ◽

Health Impact ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Prep Implementation ◽

Sub Saharan ◽

Exposure Prophylaxis

Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact.

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Cutting-Edge Success in Preventing Heterosexual HIV Transmission in Africa: Voluntary Medical Male Circumcision Has Reached 15 Million Men

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.3.232 ◽

2018 ◽

Vol 30 (3) ◽

pp. 232-242

Author(s):

Inon Schenker

Keyword(s):

Male Circumcision ◽

Randomized Clinical Trials ◽

Hiv Transmission ◽

Hiv Infections ◽

High Volume ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Sub Saharan ◽

A Minor

Male circumcision is a minor surgery performed for religious and medical reasons. Three randomized clinical trials demonstrated it could reduce heterosexual HIV transmission from infected females to males by over 60%, paving the way in 2006 for multinational efforts to circumcise 27 million men in sub-Saharan Africa by 2021. It is estimated that by 2030 male circumcision will avert at least 500,000 HIV infections in Africa, saving lives and budgets. Voluntary medical male circumcision (VMMC) of adults and adolescents has challenged policy makers, implementers, funders, and civil society in bringing surgery to the frontline of HIV prevention. Five key challenges are discussed: policy, clinical, demand, supply, and scaling up. A unique Israel-Senegal-South Africa collaboration, which enhanced high-volume (100 VMMCs per day) and high-quality (less than 2% minor adverse events) procedures, is described, highlighting VMMC as one of the most impressive public health collaborative interventions in HIV/AIDS prevention globally.

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Systematic review of the effect of economic compensation and incentives on uptake of voluntary medical male circumcision among men in sub-Saharan Africa

AIDS Care ◽

10.1080/09540121.2018.1453921 ◽

2018 ◽

Vol 30 (9) ◽

pp. 1071-1082 ◽

Cited By ~ 7

Author(s):

Maria A. Carrasco ◽

Jonathan M. Grund ◽

Stephanie M. Davis ◽

Renee Ridzon ◽

Meghan Mattingly ◽

...

Keyword(s):

Systematic Review ◽

Male Circumcision ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Sub Saharan

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A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa

International Journal of Impotence Research ◽

10.1038/s41443-021-00484-x ◽

2021 ◽

Author(s):

Winnie Kavulani Luseno ◽

Stuart Rennie ◽

Adam Gilbertson

Keyword(s):

Public Health ◽

Hiv Prevention ◽

Male Circumcision ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Ethical Implications ◽

Sub Saharan

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Making voluntary medical male circumcision services sustainable: Findings from Kenya’s pilot models, baseline and year 1

PLoS ONE ◽

10.1371/journal.pone.0252725 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252725

Author(s):

Stephanie M. Davis ◽

Nandi Owuor ◽

Elijah Odoyo-June ◽

Jonesmus Wambua ◽

Eunice Omanga ◽

...

Keyword(s):

Service Delivery ◽

Male Circumcision ◽

Service Provision ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Community Perception ◽

Medical Male Circumcision ◽

Target Volumes ◽

Group A ◽

Sub Saharan

Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of service provision domestically owned and implemented. Using pre-defined metrics, we created and evaluated three models of circumcision service delivery (static, mobile and mixed) to identify which had potential for sustaining high circumcision coverage among 10-14-year-olds group, a historically high-demand and accessible age group, at the lowest possible cost. We implemented each model in two distinct geographic areas, one in Siaya and the other in Migori county, and assessed multiple aspects of each model’s sustainability. These included numerical achievements against targets designed to reach 80% coverage over two years; quantitative expenditure outcomes including unit expenditure plus its primary drivers; and qualitative community perception of program quality and sustainability based on Likert scale. Outcome values at baseline were compared with those for year one of model implementation using bivariate linear regression, unpaired t-tests and Wilcoxon rank tests as appropriate. Across models, numerical target achievement ranged from 45–140%, with the mixed models performing best in both counties. Unit expenditures varied from approximately $57 in both countries at baseline to $44-$124 in year 1, with the lowest values in the mixed and static models. Mean key informant perception scores generally rose significantly from baseline to year 1, with a notable drop in the area of community engagement. Consistently low scores were in the aspects of domestic financing for service provision. Sustainability-focused circumcision service delivery models can successfully achieve target volumes at lower unit expenditures than existing models, but strategies for domestic financing remain a crucial challenge to address for long-term maintenance of the program.

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Tackling HIV/AIDS as a Contemporary Social Problem in Sub-Saharan Africa: ‘A Sociological Critique of Voluntary Medical Male Circumcision (VMMC) as a Preventive Measure’

Social Sciences ◽

10.11648/j.ss.20150403.16 ◽

2015 ◽

Vol 4 (3) ◽

pp. 68

Author(s):

Eliphas Machacha

Keyword(s):

Male Circumcision ◽

Social Problem ◽

Preventive Measure ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Sub Saharan ◽

Hiv Aids

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The Role of Female Partners in the uptake of Voluntary Medical Male Circumcision in Sub-Saharan Africa: A Review

Global Journal of Health Science ◽

10.5539/gjhs.v11n7p9 ◽

2019 ◽

Vol 11 (7) ◽

pp. 9

Author(s):

Celenkosini Thembelenkosini Nxumalo ◽

Gugu Gladness Mchunu

Keyword(s):

Male Circumcision ◽

Female Partner ◽

Sub Saharan Africa ◽

World Health ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Female Partners ◽

Sub Saharan ◽

Partner Involvement

BACKGROUND: Voluntary Medical Male Circumcision (VMMC) is a proven biological strategy for reducing heterosexual transmission of HIV/AIDS by up to 60%. Following recommendations from the World Health Organisation (WHO), Medical Circumcision (MC) was rolled out in South Africa. Several issues, among them being individual perceptual factors and female partner influence, have constituted as both obstacles and drivers to the uptake of VMMC. AIM: To explore and synthesize research conducted on the role of female partners in the uptake of VMMC. METHODS: Electronic searches were conducted in PUBMED, MEDLINE and CIHNAL, studies included in the review are those that explored the importance of female partner involvement in the uptake of VMMC. The review was limited to sub-Saharan Africa with a focus on peer reviewed articles written in English only. RESULTS: The review has revealed that considering the gender dimensions of circumcision, the possible utilisation of women as vehicles to drive the uptake of MC could be key to achieving the desired uptake. CONCLUSION: It is postulated that women play a key role in terms of promoting circumcision in order to facilitate a successful scale up of the service. Further research is therefore necessary so that the benefits of female partner involvement in VMMC may be achieved.

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Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0084701 ◽

2014 ◽

Vol 9 (5) ◽

pp. e84701 ◽

Cited By ~ 20

Author(s):

Lori Bollinger ◽

Adebiyi Adesina ◽

Steven Forsythe ◽

Ramona Godbole ◽

Elan Reuben ◽

...

Keyword(s):

Male Circumcision ◽

Primary Source ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Cost Drivers ◽

Source Data ◽

Sub Saharan

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Incidence of HIV in Sub-Saharan Africa, 2000–2015: The Interplay Between Social Determinants and Behavioral Risk Factors

AIDS and Behavior ◽

10.1007/s10461-021-03279-9 ◽

2021 ◽

Author(s):

Deepa Jahagirdar ◽

Magdalene Walters ◽

Avina Vongpradith ◽

Xiaochen Dai ◽

Amanda Novotney ◽

...

Keyword(s):

Incidence Rate ◽

Incidence Rates ◽

Sub Saharan Africa ◽

Behavioral Risk ◽

Hiv Incidence ◽

Hiv Knowledge ◽

African Countries ◽

Final Model ◽

Sub Saharan ◽

Disease Study

AbstractHIV incidence in sub-Saharan Africa declined substantially between 2000 and 2015. In this analysis, we consider the relative associations of nine structural and individual determinants with this decline. A linear mixed effects model of logged HIV incidence rates versus determinants was used. The data were from mathematical modelling as part of the 2019 Global Burden of Disease Study in 43 sub-Saharan African countries. We used forwards selection to determine a single final model of HIV incidence rate. The association of economic variables and HIV knowledge with incidence was found to be driven by education, while ART coverage had the largest impact on other determinants’ coefficients. In the final model, education years per capita contributed the most to explaining variation in HIV incidence rates; a 1-year increase in mean education years was associated with a 0.39 (− 0.56; − 0.2, t = − 4.48 p < 0.01) % decline in incidence rate while a unit increase in ART coverage was associated with a 0.81 (− 1.34; − 0.28, t = − 3.01, p < 0.01) % decline in incidence rate.

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