Community Engagement for the Voluntary Medical Male Circumcision (VMMC) Program: an Analysis of Key Stakeholder Roles to Promote a Sustainable Program in Zambia

Abstract BackgroundWithin the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. To date, there has been inadequate mapping of community stakeholders, their power, roles, and strategies in facilitating sustainability of VMMC programmes. We use the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. The analysis was guided by the power and interest model.MethodsData were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. ResultsDifferences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise (knowledge, skills, roles), local authority (traditional, political, religious leadership), financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power (community / family bonds). Key roles and strategies included strengthening community engagement in the planning processes by broadening local coordination and engagement systems, enhancing community involvement in providing VMMC information through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC through promoting a community-led monitoring and evaluation process, as well as improving local accountability processes in VMMC activities.ConclusionBy consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.

Download Full-text

Immediate Motivators to Seeking Voluntary Medical Male Circumcision Among HIV-Negative Adult Men in an Urban Setting in Botswana

AIDS Education and Prevention ◽

10.1521/aeap.2019.31.2.136 ◽

2019 ◽

Vol 31 (2) ◽

pp. 136-151 ◽

Cited By ~ 1

Author(s):

Lisa P. Spees ◽

Jenny H. Ledikwe ◽

Nora J. Kleinman ◽

Conrad Ntsuape ◽

Bazghina-werq Semo ◽

...

Keyword(s):

Male Circumcision ◽

Religious Affiliation ◽

High Volume ◽

Population Based ◽

Capital City ◽

Urban Setting ◽

Personal Hygiene ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Highly Educated

Randomized trials have shown that voluntary medical male circumcision (VMMC) significantly reduces HIV acquisition risk in men. We sought to identify subpopulations of Botswanan men with high levels of VMMC uptake by comparing an observational cohort of men presenting for circumcision services at two high-volume clinics in Botswana's capital city, Gabo-rone, with a matched, population-based random sample of uncircumcised men. Among these high uptake VMMC subpopulations, we then examined the immediate factors that play a role in men's decision to seek VMMC services. As compared to their population-based controls, men choosing to undergo circumcision were more likely to be ages 24–34, more highly educated, to have a religious affiliation, and in a serious relationship. Our results suggest that married men and highly educated men were more likely to pursue circumcision for personal hygiene reasons. These findings have direct implications for targeted demand creation and mobilization activities to increase VMMC uptake in Botswana.

Download Full-text

Health workers’ perspectives on implementation of an integrated medical male circumcision strategy in KwaZulu-Natal, South Africa

Health SA Gesondheid ◽

10.4102/hsag.v19i1.810 ◽

2014 ◽

Vol 19 (1) ◽

Author(s):

Rogerio Phili

Keyword(s):

Public Sector ◽

Hiv Infection ◽

Male Circumcision ◽

Health Workers ◽

Voluntary Medical Male Circumcision ◽

Reproductive Health Services ◽

Medical Male Circumcision ◽

Missed Opportunities ◽

Kwazulu Natal ◽

Randomised Controlled

Background: KwaZulu-Natal province began implementation of voluntary medical male circumcision (VMMC) as an integral part of its HIV infection prevention strategy that includes other programmes such as HIV counselling and testing (HCT), screening and treatment of sexually transmitted infections and tuberculosis, and other sexual and reproductive health services. This followed randomised controlled trials that showed up to 60% HIV infection risk reduction amongst circumcised men. Implementation of the strategy occurred despite absence of knowledge of operational barriers and its acceptability to health care workers (HCWs).Objectives: The study aimed to explore HCWs’ perspectives of and barriers to strategy implementation at public sector health facilities to inform implementation policy.Method: A purposive quota sampling method was used to select HCWs for focus group discussions at three study sites. Participants were asked open-ended questions using an interview schedule based on a literature review to explore acceptability of and perceptions regarding provision of the strategy. Thematic analysis was conducted.Results: Acceptability of the strategy was high amongst the participants; however, there was limited knowledge of some key concepts of the strategy, personnel role confusion, missed opportunities for client recruitment, and infrastructural constraints. Negative perceptions included beliefs that VMMC would discourage condom use and cause stigma associated with non-circumcision of HIV-positive males, with perceptions of sexual behavioural disinhibition in circumcised men.Conclusion: There is a need to engage further with stakeholders if implementation of VMMC is to be successful. More training and support needs to be provided to HCWs at public sector facilities.Agtergrond: Die implementering van vrywillige mediese manlike besnyding (VMMC) is ’n integrale deel van KwaZulu-Natal provinsie se MIV-voorkomingstrategie, wat ander programme soos MIV-berading, siftingstoetse (HCT) en die behandeling van seksuele oordraagbare siektes (STI), asook ander seksuele en reproduksie-gesondheidsdienste (geïntegreerde VMMC) insluit. Dit volg op die resultate van ewekansige gekontroleerde steekproewe wat ’n doeltreffendheid getoon het van tot 60% vermindering in HIV-risiko onder mans wat besny is. Die implementering van die strategie het plaasgevind ten spyte van die afwesigheid van kennis van operasionele struikelblokke of aanvaarding deur gesondheidswerkers (HCWs).Doelwitte: Die studie is daarop gerig om HCW se perspektiewe en hindernisse vir die implementering van die VMMC program by die openbare sektor se gesondheidsfasiliteite te verken, ten einde die uitvoering van die beleid vas te stel.Metode: Die doelgerigte kwotasteekproefmetode is gebruik om HCW deelnemers vir fokusgroepbesprekings (FGDs) op drie studieterreine te kies. Deelnemers is oop vrae gevra met behulp van ’n onderhoudskedule gebaseer op ’n literatuuroorsig van die aanvaarbaarheid en persepsies aangaande die voorsiening van die strategie. Tematiese analise is in ooreenstemming met die doelwitte van die studie gedoen.Resultate: Die aanvaarbaarheid van VMMC was hoog onder die deelnemers, maar ’n paar probleemareas is geïdentifieer: beperkte kennis van belangrike begrippe van die strategie, personeelrolverwarring, geleenthede vir kliëntwerwing en infrastruktuurbeperkings. Negatiewe persepsies het ingesluit: oortuigings dat VMMC die gebruik van kondome sou voorkom, die stigma wat verband hou met onbesnede HIV-positiewe mans en die persepsie van onderdrukte seksuele gedrag by mans wat besny is.

Download Full-text

Outcomes of voluntary medical male circumcision performed by medical doctors and non-doctor health workers in central Uganda

African Journal of Urology ◽

10.1186/s12301-021-00156-8 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Hope Kibansha Matumaini ◽

Anthony Batte ◽

Kennedy Otwombe ◽

Emily Lebotsa ◽

Sam Luboga

Keyword(s):

Adverse Events ◽

Male Circumcision ◽

Health Workers ◽

Scale Up ◽

Task Shifting ◽

Urethral Injury ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Post Surgery ◽

Significant Difference

Abstract Background Voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission. Task shifting of VMMCs to non-doctor health workers is recommended to enhance scale-up of VMMC programs. This study evaluated outcomes of circumcision conducted by doctors compared to non-doctors in central Uganda. Methods In this prospective observational study, we observed and followed 274 males at 3 health facilities in Kampala, Uganda. Each participant was observed during the circumcision procedure, monitored for 2 h post-surgery and assessed at 24 h, 3 days and after one week for adverse events. Results The median age of the circumcised men was 24.00(IQR, 20.00–28.00) years. Of the VMMCs, 19.3% (53/274) were carried out by doctors while 80.7% (221/274) by non-doctors. Following VMMC, 5.47% (15/274) men experienced adverse events and proportions of adverse events by cadre were similar; doctors (5.66% [3/53]) and non-doctor health workers (5.43% [12/221]), p = 0.99. Seven participants had pus discharge (all had been operated by non-doctors), 2 participants had bleeding at 2 h (one by doctor and one by non-doctor), and 4 participants had excessive skin removal (2 by doctors vs 2 by non-doctors). There was no reported urethral injury or glans amputation. Conclusion Our study found no statistically significant difference in the incidence of adverse events among VMMCs conducted by doctors compared to non-doctor health workers. Our study showed no incidence of serious adverse events such as death, urethral injury or glans amputation following VMMCs. Our results add to the existing literature to guide task shifting in the context of VMMCs.

Download Full-text