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 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 The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

2021 ◽  
Vol 5 ◽  
pp. 15
Author(s):  
Eline L. Korenromp ◽  
Anna Bershteyn ◽  
Edina Mudimu ◽  
Renay Weiner ◽  
Collen Bonecwe ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Hiv Transmission ◽  
Scale Up ◽  
Household Survey ◽  
Hiv Infections ◽  
Treatment Needs ◽  
Medical Male Circumcision ◽  
Hiv Epidemic ◽  
The Impact

Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.

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.

scholarly journals Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

2015 ◽  
Vol 3 (3) ◽  
pp. 503-515 ◽  
Author(s):  
Hally Mahler ◽  
Sarah Searle ◽  
Marya Plotkin ◽  
Yusuph Kulindwa ◽  
Seth Greenberg ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision
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