scholarly journals Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services

2021 ◽  
pp. sextrans-2020-054776
Author(s):  
Wezi Msungama ◽  
Geoffrey Menego ◽  
Frackson Shaba ◽  
Nicole Flowers ◽  
Melissa Habel ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Hiv Risk ◽  
Male Circumcision ◽  
Voluntary Medical Male Circumcision ◽  
Community Mobilisation ◽  
Medical Male Circumcision ◽  
Improvement Project ◽  
Sexually Transmitted ◽  
Targeted Interventions ◽  
Demand Creation

IntroductionVoluntary medical male circumcision (VMMC), an effective HIV prevention programme for men, is implemented in East and Southern Africa. Approximately 50% of VMMC clients are aged below 15 years. More targeted interventions to reach older men and others at higher short-term HIV risk are needed.MethodsWe implemented a quality improvement project testing the effectiveness of an active referral-based VMMC recruitment approach, targeting men attending STI clinics and those escorting partners to antenatal care (ANC) clinics, at Bwaila Hospital in Lilongwe, Malawi. We compared the proportions aged older than 15 years among men who received VMMC following referral from STI and ANC clinics with those among men referred from standard community mobilisation. We also analysed referral cascades to VMMC.ResultsIn total, 330 clients were circumcised after referral from STI (242) and ANC (88) clinics, as compared with 3839 other clients attributed to standard community mobilisation. All clients from ANC and STI clinics were aged over 15 years, as compared with 69% from standard community mobilisation. STI clinics had a higher conversion rate from counselling to VMMC than ANC (12% vs 9%) and a higher contribution to total circumcisions performed at the VMMC clinic (6% vs 2%).ConclusionsIntegrating VMMC recruitment and follow-up in STI and ANC clinics co-located with VMMC services can augment demand creation and targeting of men at risk of HIV, based on age and STI history. This approach can be replicated at least in similar health facilities with ANC and STI services in close proximity to VMMC service delivery.

scholarly journals Effectiveness of Demand creation promotions and demand creation personnel in creating demand for Voluntary Medical Male Circumcision in Chitungwiza district, Zimbabwe in 2016

2018 ◽  
Author(s):  
Taurai Matikiti ◽  
Tsitsi P Juru ◽  
Notion Gombe ◽  
Peter Nsubuga ◽  
Mufuta Tshimanga
Keyword(s):  
Male Circumcision ◽  
Service Providers ◽  
Sampling Technique ◽  
Professional Judgment ◽  
Voluntary Medical Male Circumcision ◽  
Age Group ◽  
Medical Male Circumcision ◽  
Hiv Prevention Intervention ◽  
Demand Creation ◽  
Eastern And Southern Africa

AbstractZimbabwe is one of the 14 countries in eastern and southern Africa that have adopted Voluntary Medical Male Circumcision (VMMC) as an HIV prevention intervention in response to WHO’s recommendation for countries with generalised high HIV epidemics and low VMMC prevalence. However, since 2013 when VMMC was scalled up in Zimbabwe, there was a general low uptake of the VMMC programme particularly on the target age group 20-29 years which has an immediate reduction in the HIV burden. The failure of VMMC uptake in the priority age group prompted the need to analyse the effectiveness of demand creation promotions and personnel used in creating demand for VMMC in Chitungwiza district, Zimbabwe. We employed judgmental sampling, a non-probability sampling technique where we interviewed VMMC clients (n=50) and service providers (n=10) using self administered questions, and community mobilisers (n=10) and demand creation teams (n=3) using face-to-face interviews based on their experience, knowledge and professional judgment. We also randomly analysed client records in the form of 50 Client Intake Forms (CIF) books. We found out that Community mobilisers and Demand creation officers were effective in mobilising clients in the age group 10-15 years and 16-30 years respectively. The use of clinicians (nurses) was also found to be useful in creating demand for VMMC. We also found out that intensifying campaigns during school holidays, the use of tent-based/caravan campaigns and the door to door campaigns were most effective strategies under demand creation promotions. We concluded that there is need to increase demand creation officers and qualified community mobilisers. To regulary train and motivate current community mobilisers as well as increasing the use of clinicians(nurses) in demand creation. We recommended the need to increase the number of mobile caravans and intensifying on the door to door campaigns in the district.

scholarly journals Innovative Demand Creation for Voluntary Medical Male Circumcision Targeting a High Impact Male Population

2016 ◽  
Vol 72 ◽  
pp. S278-S284 ◽  
Author(s):  
Aggrey S. Semeere ◽  
Barbara Castelnuovo ◽  
Denis S. Bbaale ◽  
Agnes N. Kiragga ◽  
Joanita Kigozi ◽  
...  
Keyword(s):  
Male Circumcision ◽  
High Impact ◽  
Voluntary Medical Male Circumcision ◽  
Male Population ◽  
Medical Male Circumcision ◽  
Demand Creation

scholarly journals Innovative demand creation strategies to increase voluntary medical male circumcision uptake: a pragmatic randomised controlled trial in Zimbabwe

2021 ◽  
Vol 6 (Suppl 4) ◽  
pp. e006141
Author(s):  
Webster Mavhu ◽  
Melissa Neuman ◽  
Karin Hatzold ◽  
Stephen Buzuzi ◽  
Galven Maringwa ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Interpersonal Communication ◽  
Male Circumcision ◽  
Controlled Trial ◽  
Final Analysis ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Demand Creation ◽  
Randomised Controlled ◽  
The Impact

IntroductionReaching men aged 20–35 years, the group at greatest risk of HIV, with voluntary medical male circumcision (VMMC) remains a challenge. We assessed the impact of two VMMC demand creation approaches targeting this age group in a randomised controlled trial (RCT).MethodsWe conducted a 2×2 factorial RCT comparing arms with and without two interventions: (1) standard demand creation augmented by human-centred design (HCD)-informed approach; (2) standard demand creation plus offer of HIV self-testing (HIVST). Interpersonal communication (IPC) agents were the unit of randomisation. We observed implementation of demand creation over 6 months (1 May to 31 October 2018), with number of men circumcised assessed over 7 months. The primary outcome was the number of men circumcised per IPC agent using the as-treated population of actual number of months each IPC agent worked. We conducted a mixed-methods process evaluation within the RCT.ResultsWe randomised 140 IPC agents, 35 in each arm. 132/140 (94.3%) attended study training and 105/132 (79.5%) reached at least one client during the trial period and were included in final analysis. There was no evidence that the HCD-informed intervention increased VMMC uptake versus no HCD-informed intervention (incident rate ratio (IRR) 0.87, 95% CI 0.38 to 2.02; p=0.75). Nor did offering men a HIVST kit at time of VMMC mobilisation (IRR 0.65, 95% CI 0.28 to 1.50; p=0.31). Among IPC agents that reported reaching at least one man with demand creation, both the HCD-informed intervention and HIVST were deemed useful. There were some challenges with trial implementation; <50% of IPC agents converted any men to VMMC, which undermined our ability to show an effect of demand creation and may reflect acceptability and feasibility of the interventions.ConclusionThis RCT did not show evidence of an effect of HCD-informed demand intervention or HIVST on VMMC uptake. Findings will inform future design and implementation of demand creation evaluations.Trial registration numberPACTR201804003064160.

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