scholarly journals Adapting “MOVE” to Accelerate VMMC Coverage for HIV Prevention in Priority Populations: Implementation Experiences from Uganda’s Military Settings

2021 ◽  
pp. 39-52
Author(s):  
A. Nyanzi ◽  
E. Lugada ◽  
D. Bwayo ◽  
V. Kasujja ◽  
C. Wamundu ◽  
...  
Keyword(s):  
Scale Up ◽  
Cost Effective ◽  
Integrated Approach ◽  
Health Facilities ◽  
Health System Strengthening ◽  
Voluntary Medical Male Circumcision ◽  
Intervention Package ◽  
Medical Male Circumcision ◽  
Military Health ◽  
Performance Trends

This paper describes the WHO’s Model of Optimizing Volumes and Efficiencies (MOVE), adapted by the University Research Council (URC) - Department of Defense HIV/AIDS Prevention Program (DHAPP) to rapidly scale up Voluntary Medical Male Circumcision (VMMC) within Uganda’s military health facilities. First, we examine the MOVE model and then present the URC-DHAPP adapted intervention package comprising of: a) a Command-driven approach, b) Mobile theatres c) Quality assurance d) Data strengthening and reflection. To expand VMMC, URC-DHAPP worked with army commanders to create awareness, mobilize their troops and surgeons were assigned daily targets. The mobile theatre involved regular visits to hard-to-reach outposts and placing several mobile camps at health facilities close to deployment sites. All stakeholders were briefed on performance trends of previous medical camps and the program was monitored through VMMC camp reports. URC-DHAPP registered an exponential increase in VMMC coverage from 13% performance at Q2 to over 140% in Q4. The integrated approach led to circumcision of over 22,000 men (15-49 years) in a record four months. Our approach also contributed to health system strengthening and national HIV preventiontargets. We conclude that the MOVE is cost-effective and can be successfully scaled up in resource-limited settings with a high HIV burden when implemented with cognizance of contextual specificities.

scholarly journals Accelerated Scale up of Voluntary Medical Male Circumcision within the Military Health Services in Uganda: The Race towards 2020 HIV Epidemic Control

2021 ◽  
pp. 1-15
Author(s):  
E. Lugada ◽  
G. Seruwagi ◽  
A. Nyanzi ◽  
S. Lawoko ◽  
D. Bwayo ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Unit Cost ◽  
Scale Up ◽  
Voluntary Medical Male Circumcision ◽  
Epidemic Control ◽  
Medical Male Circumcision ◽  
Military Health ◽  
Multiple Stakeholder ◽  
Hiv Epidemic ◽  
The Military

Background: Scaling up Voluntary Medical Male Circumcision (VMMC) is a critical intervention in achieving HIV epidemic control by 2020. However, documentation of programmatic interventions to improve VMMC uptake among military populations, a population that is at high risk of HIV, is lacking. URC-Department of Defense HIV/AIDS Prevention Program (DHAPP) implemented a novel approach to accelerate VMMC uptake in the Ugandan military.  We describe trends in VMMC uptake and associated operational costs following the intervention. We also contrast between military and civilian facilities. Program Description: We implemented monthly mobile VMMC services throughout the country targeting soldiers, their families and surrounding communities. Records gathered during implementation were used to describe the intervention. Quantitative methods were applied to compare VMMC post intervention rates with set targets and monthly VMMC trends country-wide between military and civilian facilities over a five months period. An operational VMMC service cost analysis was applied to determine per male circumcision unit cost, excluding cost of consumables. Lessons Learnt: Command-driven mobilization, multiple stakeholder engagement, use of mobile VMMC teams and data-driven planning increased demand for and uptake of VMMC services among the military. By the first month of intervention, VMMC performance had surpassed set monthly targets of 1,474 by 1457 circumcisions, accounting for a 99% increase (n=2,931 circumcisions) from 31% to 62% uptake. Overall VMMC performance achieved within the military was 132% in excess of set targets (n=7,408) at six months. The scaled-up operational VMMC cost per circumcision performed dropped from $15 to $7, a 47% unit cost saving within six months. While a positive trend in VMMC uptake was observed in the military facilities, the opposite was exhibited in civilian facilities over the observation period. Conclusion: It is feasible to rapidly scale up circumcision coverage in populations served by military health facilities through mobile short term episodic VMMC services which optimize volume and efficiency. Invoking command-led mobilization and multiple stakeholder involvement is critical in demand creation and overcoming the mobile nature of the military.

scholarly journals Differences in Adverse Events Related to Voluntary Male Medical Circumcision Between Civilian and Military Health Facilities in Uganda

2021 ◽  
Author(s):  
Lucky Ogweng Obangaber ◽  
Gloria Seruwagi ◽  
Maria Sarah Nabaggala ◽  
Eric Lugada ◽  
Denis Bwayo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Health Facilities ◽  
P Value ◽  
Voluntary Medical Male Circumcision ◽  
Military Population ◽  
Medical Male Circumcision ◽  
Military Health ◽  
Catchment Areas ◽  
Trends Analysis ◽  
The Military

Abstract Background: Voluntary medical male circumcision (VMMC) significantly reduces the risk of acquiring HIV in men. Despite the percentage of circumcised men (15-49 years) in Uganda increasing over time, some populations are not taking up the surgical procedure. The government of Uganda and implementing partners have responded to this lack of VMMC coverage among key populations by intensifying introducing innovative strategies that increase demand particularly among military personnel using the WHO’s MOVE strategy. As a surgical intervention, it is critical that VMMC services are safe for clients and that adverse events or complications are minimized. This paper describes the prevalence and trends of adverse events reported among military mobile camps in comparison to civilian sites in Uganda. Methods: A prospective study conducted in eighteen (18) public health facilities between March and August 2019. Of these nine (9) were providing care to civilian populations while nine (9) served the military population and catchment areas. Descriptive statistics, Chi-square test and trends analysis were carried out to describe profile of advance events among civilian and military facilities over the study period. Results: The highest proportions of VMMC were done among persons aged 15 to 19 years whereas among military camps the highest proportions of circumcision among males aged 20 to 24 years. Regarding site of circumcision, the highest proportions of VMMC were done at outreaches, with higher levels in military camps compared to civilian camps. For the proportions of adverse events reported, higher proportions were reported in civilian camps compared to military camps (Total – 1.3% vs 0.2%; p- value<0.05). For trends analysis, results indicate that there was no statistically significant trend for both civilian and military number of adverse events reported for the four quarters in 2020 (P-value =0.315 for civilian and P=0.094 for the military). Conclusions: The MOVE model is great for scaling up VMMC in specialized populations such as military. Can also be adapted in other populations if contextual bottlenecks are identified and collectively addressed by key stakeholders – leadership, community engagement and using a largely horizontal approach offer promising possibilities and outcomes.

scholarly journals Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya

2019 ◽  
Vol 23 (12) ◽  
pp. 3460-3470 ◽  
Author(s):  
Winnie K. Luseno ◽  
Samuel H. Field ◽  
Bonita J. Iritani ◽  
Stuart Rennie ◽  
Adam Gilbertson ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Psychosocial Distress ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Western Kenya

scholarly journals Age targeting and scale-up of voluntary medical male circumcision in Mozambique

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0211958 ◽  
Author(s):  
Juan Dent ◽  
Nuno Gaspar ◽  
Emmanuel Njeuhmeli ◽  
Katharine Kripke
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision

scholarly journals Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa

PLoS Medicine ◽  
2011 ◽  
Vol 8 (11) ◽  
pp. e1001129 ◽  
Author(s):  
Kelly Curran ◽  
Emmanuel Njeuhmeli ◽  
Andrew Mirelman ◽  
Kim Dickson ◽  
Tigistu Adamu ◽  
...  
Keyword(s):  
Human Resource ◽  
Male Circumcision ◽  
Scale Up ◽  
Eastern Africa ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Resource Needs

scholarly journals Tetanus Adverse Event after VMMC for HIV Prevention in a Pre-circumcision Tetanus Immunized Male from Uganda: A Case Report

2021 ◽  
pp. 6-10
Author(s):  
E. Lugada ◽  
A. Nyanzi ◽  
D. Bwayo ◽  
H. Musinguzi ◽  
J. Akao ◽  
...  
Keyword(s):  
Case Report ◽  
Male Circumcision ◽  
Scale Up ◽  
Developed Countries ◽  
Local Health ◽  
Voluntary Medical Male Circumcision ◽  
Vaccine Failure ◽  
Medical Male Circumcision ◽  
Post Vaccination ◽  
Tetanus Vaccination

Background: Although tetanus is a life-threatening disease, its occurrence is rare in the post-vaccination era, especially in developed countries. The US President’s Emergency Plan for AIDS Relief (PEPFAR) has supported scale up of Voluntary Medical Male Circumcision (VMCC) to reduce female-to-male HIV transmission in countries with a high prevalence of HIV. VMMC is generally safe, with less than 2% of clients experiencing moderate to severe adverse events. However, in most sub-Saharan countries with a high HIV prevalence and low male circumcision coverage, tetanus vaccination overage among infants, especially male, remains suboptimal. This is a case report of a 45-year-old male who developed tetanus after pre-circumcision tetanus vaccination in a VMMC HIV/AIDS prevention intervention program in Uganda. The Case: A healthy 45-year-old male presented for voluntary circumcision at field VMMC centre. He received a standard pre-circumcision tetanus immunization and had no incident immediate post-operative. 14 days later he reported at a local health facility with a history of difficulty in swallowing, difficulty in breathing, loss of speech and was ultimately diagnosed with tetanus after 2 days. The patient was immediately admitted in intensive care unit, treated, improved and eventually discharged. Conclusions: This report highlights the possibility of tetanus vaccine failure and importance of prompt diagnosis and treatment of tetanus. It also highlights the need for institution of aggressive quality improvement and pre-circumcision tetanus vaccination procedures. Post vaccination surveillance for possible vaccine failure is recommended in addition to a review of existing national immunization medical practice and policies.

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

2018 ◽  
Vol 29 (14) ◽  
pp. 1432-1443 ◽  
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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