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

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.

scholarly journals Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa

PLoS ONE ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. e96468 ◽  
Author(s):  
Carl Montague ◽  
Nelisiwe Ngcobo ◽  
Gethwana Mahlase ◽  
Janet Frohlich ◽  
Cheryl Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
School Based ◽  
Kwazulu Natal

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

2021 ◽  
Author(s):  
Joseph Mumba Zulu ◽  
Trevor Mwamba ◽  
Alyssa Rosen ◽  
Tulani Francis L. Matenga ◽  
Joseph M Mulanda ◽  
...  
Keyword(s):  
Social Media ◽  
Community Engagement ◽  
Male Circumcision ◽  
Rural Areas ◽  
Health Workers ◽  
Health Centre ◽  
Urban Setting ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Community Stakeholders

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.

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.

scholarly journals The development of an explanatory model for voluntary medical male circumcision in KwaZulu-Natal, South Africa

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Primary Healthcare ◽  
Explanatory Model ◽  
Outcome Variable ◽  
Care Practice ◽  
Model Description ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Background: KwaZulu-Natal (KZN) remains the epicentre of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in South Africa. The incidence of HIV infection in KZN necessitates cost-effective strategies to curb the spread of infection. Voluntary medical male circumcision (VMMC) has been adopted as an additional biomedical preventive strategy since 2010 in line with recommendations from the World Health Organization. Despite several attempts to scale-up VMMC to reach age specific targets to achieve immediate aversion of infections, the uptake of VMMC remains sub-optimal, particularly in KZN. The purpose of this study is to describe the processes that were followed in developing, describing and evaluating an explanatory model for VMMC in KZN, South Africa.Methods: A qualitative theory-generative phenomenographic study design was used to analyse the qualitative differences in primary healthcare stakeholders’ experiences, understanding and conceptions of VMMC in KZN, South Africa. The emerging results informed the development of the VMMC explanatory model for KZN, South Africa. The model development process followed four steps, namely (1) concept analysis, (2) construction of relational statements, (3) model description and (4) model evaluation. The criteria of relevance for the target audience – applicability, clarity, user friendliness and originality of work – were used to evaluate the model.Results: The model’s central premise is that the decision to undergo VMMC is shaped by a complex interplay of factors in the context or external environment of males (the extrinsic variable), which influences specific experiences, conceptions and understanding regarding VMMC (the influential/intrinsic variables). These collectively determine men’s responses to VMMC (the outcome variable).Conclusion: The model describes the process by which contextual, extrinsic and intrinsic variables interact to determine an individual male’s response to VMMC, thus providing a guide to primary healthcare providers on care, practice and policy interventions to support the uptake of VMMC in the rural primary healthcare context of KZN, South Africa.

scholarly journals Healthcare providers’ perceptions and understanding of voluntary medical male circumcision in KwaZulu-Natal, South Africa: A qualitative study

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Healthcare Workers ◽  
Scale Up ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Heterosexual Transmission ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Background: There is compelling evidence that voluntary medical male circumcision (VMMC) reduces the chances of heterosexual transmission of HIV infection. Healthcare workers are among the key influencers in terms of the scale-up of VMMC as they are often involved in mobilisation for uptake. There is a paucity of qualitative research on healthcare workers’ experiences, understanding and perceptions of VMMC; particularly in the South African rural primary healthcare context. This study was conducted to examine healthcare workers perceptions and understanding of VMMC in KwaZulu-Natal, South Africa.Methods: The study employed a qualitative approach using a phenomenographic design. A purposive sample of 15 doctors, nurses and clinical associates working in 6 different rural clinics in KwaZulu-Natal, South Africa, were interviewed in English in-depth using a semi-structured interview schedule. The interviews were audio-recorded, and transcribed. The results were analysed thematically using phenomenographic data analysis procedures.Results: Categories of description in participants’ perceptions and understanding of VMMC emerged. The findings of this study revealed that healthcare workers perceptions and understanding of VMMC were predominantly influenced by the hegemonic religious and cultural norms associated with male circumcision in KwaZulu-Natal, South Africa.Conclusion: The findings of this study suggest that tailored training to address healthcare workers misperceptions and poor understanding of VMMC is necessary to ensure that they become effective custodians for VMMC implementation.

scholarly journals Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa

2020 ◽  
Vol 14 (2) ◽  
pp. 155798831989243
Author(s):  
Celenkosini Thembelenkosini Nxumalo ◽  
Gugu Gladness Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Low Income ◽  
Cultural Beliefs ◽  
Scale Up ◽  
Rural Setting ◽  
Voluntary Medical Male Circumcision ◽  
Semistructured Interview ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Voluntary Medical Male Circumcision (VMMC) is proven to reduce transmission of HIV/AIDS. Despite concerted efforts to scale up VMMC in men aged 18–49, the number of medically circumcised men in this age group remains suboptimal. Research has shown that several individual factors hinder and promote uptake of VMMC. The nature of these factors is not clearly understood within the dimensions of religion, culture and tradition, particularly in a low-income rural setting. This study aimed to analyze Zulu men’s conceptions, understanding and experiences regarding VMMC in KwaZulu-Natal (KZN), South Africa. A qualitative phenomenographic study approach was used to collect data from 20 uncircumcised males at six different clinics that provide VMMC services. Ethical approval to collect data was obtained from the Biomedical Research Ethics Committee of the University of KZN (BREC – BE627/18). Individual in-depth face to face interviews were conducted using a semistructured interview guide. Audiotapes were used to record interviews which were transcribed verbatim and then analyzed manually. The conceptions regarding medical circumcision appeared to be related to religious and cultural beliefs surrounding circumcision and the historical traditional practice thereof. The understanding of males regarding VMMC was mainly attributed to HIV prevention; however, knowledge on the degree of partial protection appeared to be limited. An array of negative accounted in the form of complications such as poor wound healing and postoperative pain undergone by peers and other close influencers’ accounted for participants’ experiences of VMMC. Poor knowledge and negative experiences relating to VMMC could account for reasons why men choose not to undergo VMMC.

scholarly journals Healthcare workers’ perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Health Care ◽  
Male Circumcision ◽  
Health Care Workers ◽  
Healthcare Workers ◽  
World Health ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Care Workers ◽  
Kwazulu Natal

Background: Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention.Aim: To analyse health care workers’ perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA.Setting: The study took place at six different health districts and their six respective rural clinics in the KZN province of SA.Methods: A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure.Results: Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported.Conclusion: The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers’ needs for training and preparation is crucial for successful implementation of VMMC.

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