Abstract
The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency-including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing-the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.
Highlights
Several randomized controlled trials have demonstrated the safety and efficacy of voluntary medical male circumcision (VMMC) in HIV transmission prevention among heterosexual men [1,2,3]
A national situation assessment on VMMC reported that 93% of respondents in traditionally non-circumcising areas of Tanzania would take their sons to be circumcised if the services were
We describe the campaign’s approach to service delivery and the factors that influenced its quality, efficiency, and safety, and we discuss how the experiences of this campaign might serve as a model for future VMMC campaigns in the Iringa Region and elsewhere
Summary
Several randomized controlled trials have demonstrated the safety and efficacy of voluntary medical male circumcision (VMMC) in HIV transmission prevention among heterosexual men [1,2,3]. Human Resources The regional campaign committee developed a human resources plan that considered the WHO guidance for improving efficiencies, the number of surgical bays available, the expected client load, and available counseling and clinical staff In this assembly-line service model, every four beds at a site required one circumcising surgeon, four bed nurses, one or two equipment and commodities runners, an equipment cleaner, and two HIV counselors. To reduce client congestion during initial and follow-up visits and increase efficiency, the campaign provided additional trained counselors to prepare a large number of clients for the surgery; added tents and other temporary structures at VMMC sites (Figure 1) to create additional space for counseling, postoperative follow-up, and data entry; scheduled clients up to two weeks in advance of surgery; paid special attention to maintaining the motivation of participating health care workers; and developed campaign-specific data monitoring tools.
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