Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania.

Erick Mlanga,Georgina Msemo,Semakaleng Phafoli,Jackson Lija,Hally Mahler,Mbaraka Amuri,Dorica Boyee,Augustino Hellar,Alice Christensen,Mustafa Njozi,Aisha Yansaneh,Marya Plotkin,Emmanuel Njeuhmeli

doi:10.9745/ghsp-d-15-00210

Abstract

Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa.

Highlights

Global Health: Science and Practice 2016 | Volume 4 | Supplement 1 approximately 60%.1–3 In March 2007, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued guidance urging countries with high HIV prevalence, low male circumcision rates, and a generalized HIV epidemic to incorporate voluntary medical male circumcision (VMMC) into their comprehensive HIV prevention programs.[4] Tanzania had an overall circumcision prevalence of 66.8% at the start of the VMMC program in 2009,5 Iringa region had a lower circumcision prevalence (29% of male adults) and at the time was Tanzania’s most HIV-affected region, with an adult HIV prevalence of 15.7%.5 the Tanzanian Ministry S29
12,678 male infants in total were born in the 8 pilot facilities; 16.4% of these were circumcised through the early infant male circumcision (EIMC) pilot program
We found that the majority of infants were circumcised in the 8- to 60-day period, making the integration of EIMC with reproductive and child health (RCH)— immunization services— critical to reaching male infants born at home

Summary

Introduction

Global Health: Science and Practice 2016 | Volume 4 | Supplement 1 approximately 60%.1–3 In March 2007, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued guidance urging countries with high HIV prevalence, low male circumcision rates, and a generalized HIV epidemic to incorporate VMMC into their comprehensive HIV prevention programs.[4] Tanzania had an overall circumcision prevalence of 66.8% at the start of the VMMC program in 2009,5 Iringa region had a lower circumcision prevalence (29% of male adults) and at the time was Tanzania’s most HIV-affected region, with an adult HIV prevalence of 15.7%.5 the Tanzanian Ministry S29. Global Health: Science and Practice 2016 | Volume 4 | Supplement 1 approximately 60%.1–3. In March 2007, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued guidance urging countries with high HIV prevalence, low male circumcision rates, and a generalized HIV epidemic to incorporate VMMC into their comprehensive HIV prevention programs.[4]. Tanzania had an overall circumcision prevalence of 66.8% at the start of the VMMC program in 2009,5 Iringa region had a lower circumcision prevalence (29% of male adults) and at the time was Tanzania’s most HIV-affected region, with an adult HIV prevalence of 15.7%.5.

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Conclusion