Article

Mass safe male circumcision: Early lessons from a Ugandan urban site - A case study

International Hospital Kampala, Uganda.
Pan African Medical Journal 12/2012; 13:88.
Source: PubMed

ABSTRACT

It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach.
A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented.
A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs.
Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.

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Available from: Moses Galukande, Oct 17, 2015
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    • "This has been successfully done in the case of Malawi where non physician clinicians (NPC), have been trained to do caesarean sections at the district hospitals resulting in improved obstetric care [9]. Task optimisation using lower cadre health workers has also been very successful for safe male circumcision in Tanzania [10] and Uganda [11,12]. Several authors have identified the district/general hospital as a key location for attending to these surgical conditions [6,8,13,14]. "
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    • "As a result of the policy, several strategies including limited offer of free circumcision at public health facilities, mobilization and sensitization of the population have been put in place to up-scale male medical circumcision in Uganda. Furthermore, in light of the research agenda of the policy, several studies (Galukande et al., 2012; Kitara et al., 2013) have also been undertaken to provide evidence based information useful in future programming of circumcision programs or services in the country. "
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    • "As a result of the policy, several strategies including limited offer of free circumcision at public health facilities, mobilization and sensitization of the population have been put in place to scale-up SMC in Uganda. Furthermore, in light of the research agenda of the policy, studies [10,11] have also been undertaken to provide evidence based information useful in future programming of circumcision programs or services in the country. "
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