Acceptability of Medical Male Circumcision Among Uncircumcised Men in Kenya One Year After the Launch of the National Male Circumcision Program

BACKGROUND: Numerous studies have demonstrated that male circumcision (MC) reduces the incidence of the Type-1 human immunodeficiency virus (HIV) among heterosexual men by at least half. METHODS: One year after the launch of a national Voluntary Medical Male Circumcision program in Kenya, this study conducted 12 focus group discussions among uncircumcised men in Nyanza Province to assess the revealed, non-hypothetical, facilitators and barriers to the uptake of MC. RESULTS: The primary barriers to MC uptake included time away from work; culture and religion; possible adverse events; and the post-surgical abstinence period. The primary facilitators of MC uptake included hygiene; social pressure; protection against HIV and other sexually transmitted infections; and improved sexual performance and satisfaction. CONCLUSIONS: Some activities which might increase MC uptake include dispelling MC misconceptions; increasing involvement of religious leaders, women's groups, and peer mobilizers for MC promotion; and increasing the relevance of MC among men who are already practicing an HIV prevention method

Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year

In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention.This paper uses data from a health facility needs assessment (n = 81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (n = 2,675 VMMC clients) to describe Kenya's experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK's decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV.This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya's VMMC implementation experience are likely generalizable to other African countries

Estimating the Population Size of Female Sex Workers in Zimbabwe: Comparison of Estimates Obtained Using Different Methods in Twenty Sites and Development of a National-Level Estimate.

BACKGROUND: National-level population size estimates (PSEs) for hidden populations are required for HIV programming and modelling. Various estimation methods are available at the site-level, but it remains unclear which are optimal and how best to obtain national-level estimates. SETTING: Zimbabwe. METHODS: Using 2015-2017 data from respondent-driven sampling (RDS) surveys among female sex workers (FSW) aged 18+ years, mappings, and program records, we calculated PSEs for each of the 20 sites across Zimbabwe, using up to 3 methods per site (service and unique object multipliers, census, and capture-recapture). We compared estimates from different methods, and calculated site medians. We estimated prevalence of sex work at each site using census data available on the number of 15-49-year-old women, generated a list of all "hotspot" sites for sex work nationally, and matched sites into strata in which the prevalence of sex work from sites with PSEs was applied to those without. Directly and indirectly estimated PSEs for all hotspot sites were summed to provide a national-level PSE, incorporating an adjustment accounting for sex work outside hotspots. RESULTS: Median site PSEs ranged from 12,863 in Harare to 247 in a rural growth-point. Multiplier methods produced the highest PSEs. We identified 55 hotspots estimated to include 95% of all FSW. FSW nationally were estimated to number 40,491, 1.23% of women aged 15-49 years, (plausibility bounds 28,177-58,797, 0.86-1.79%, those under 18 considered sexually exploited minors). CONCLUSION: There are large numbers of FSW estimated in Zimbabwe. Uncertainty in population size estimation should be reflected in policy-making

A Study Assessing the Implementation of Male Circumcision as an HIV Prevention Strategy in Kenya

A Study Assessing the Implementation of Male Circumcision as an HIV Prevention Strategy in Kenya Amy Kate Noel Herman-Roloff B.A., Bethel University, 2000 M.P.H., University of Minnesota, 2003 Dissertation Chairperson: Dr. Robert C. Bailey Research has demonstrated that male circumcision (MC) reduces the incidence of HIV acquisition in heterosexual men by at least half. In 2008, Kenya launched the national Voluntary Medical Male Circumcision (VMMC) program for HIV prevention, and plans to circumcise 860,000 males by 2013. Despite the protective effect of MC, there are concerns about the acceptability and safety of the procedure. This study was implemented in Nyanza Province, Kenya, and used a mixed method approach to assess components of the VMMC program. The quantitative component of this study used both passive (N = 3,705) and active (N = 1,449) surveillance methods to monitor study participants. The qualitative component of this study included 12 focus group discussions among uncircumcised men. The primary barriers to VMMC uptake included time away from work; culture and religion; possible adverse events (AEs); and the post-surgical abstinence period. The primary facilitators to VMMC uptake included hygiene; social pressure; protection against HIV and other sexually transmitted infections; and improved sexual performance and satisfaction. Among the participants who underwent circumcision, the post-MC AE rate was 2.1% in the passive system and 7.5% in the active system. Experienced VMMC providers, who had performed more than 100 procedures, were less likely to provide an MC that resulted in an AE compared to inexperienced providers. Approximately one-third of participants reported engaging in sexual activity during the recommended 42-day abstinence period. In a multivariable analysis, being married was the strongest predictor of engaging in early sexual activity. To increase VMMC uptake it is important to dispel misconceptions and increase the relevance of MC among men who are already practicing an HIV prevention method. As large-scale MC programs continue to be implemented throughout Africa, robust surveillance is crucial to identify factors that may improve the safety and efficacy of the program. The most important factor to reduce the AE rate is to ensure that providers achieve clinical expertise before they perform unsupervised procedures. Strategies to reduce engaging in early sexual activity should be implemented such as including female partners in counseling, mass education campaigns, and targeted programs for VMMC clients

Ethiopia(2011): MAP study mapping and estimating the size of female sex workers population in Addis Ababa/Ethiopia.

The mapping and size estimation of female sex workers(FSWs) population was done at Addis Ababa, the capital of Ethiopia. The purpose of the study was to inform the HIV prevention program about the size, type and distribution of FSWs in the capital. A combination of census and capture-recapture methods were applied

Factors associated with the safety of voluntary medical male circumcision in Nyanza province, Kenya

OBJECTIVE: To determine factors associated with the incidence of adverse events associated with voluntary medical male circumcision (VMMC) for the prevention of HIV infection in Nyanza province, Kenya. METHODS: Males aged 12 years or older who underwent VMMC between November 2008 and March 2010 in 16 clinics in three districts were followed through passive surveillance to monitor the incidence of adverse events during and after surgery. A subset of clinic participants was randomly selected for active surveillance post-operatively and was monitored for adverse events through a home-based, in-depth interview and a genital exam 28 to 45 days after surgery. Performance indicators were assessed for 167 VMMC providers. FINDINGS: The adverse event rate was 0.1% intra-operatively and 2.1% post-operatively among clinic system participants (n = 3705), and 7.5% post-operatively among participants under active surveillance (n = 1449). Agreement between systems was moderate (κ: 0.20; 95% confidence interval, CI: 0.09-0.32). Providers who performed more than 100 procedures achieved an adverse event rate of 0.7% and 4.3% in the clinic and active surveillance systems, respectively, and had decreased odds of performing a procedure resulting in an adverse event. With provider experience, the mean duration of the procedure also dropped from 24.0 to 15.5 minutes. Among providers who had performed at least 100 procedures, nurses and clinicians provided equivalent services. CONCLUSION: To reduce the adverse event rate, one must ensure that providers achieve a desired level of experience before they perform unsupervised procedures. Adverse events observed by the provider as well as those perceived by the client should both be monitored

Rwanda (2012): TRaC Malaria Control Behavioral Tracking Survey

Rwanda is a small, land-locked country in the Great Lakes region of Eastern Africa, with the entire population at risk for malaria, including an estimated 1.8 million children under five and 450,000 pregnant women per year. During the last four years, Rwanda has made significant progress in scaling up malaria control interventions, including promoting insecticide treated bed nets (ITNs), indoor residual spraying (IRS), and prompt fever treatment. PSI's current activities in Rwanda include targeting LLINs delivery from the central level to the hea lth centers level, providing prepackaged malaria treatment in the public sector, and supporting BCC activities for IRS and ITN use. Funding for PSI Rwanda activities comes from USAID-BCSM and the Global Fund. The purpose of the current study is to provide an assessment of the key health behaviors associated with bednet use and prompt fever treatment and to evaluate which communication channels have the strongest impact with regards to malaria control activities. The population for this study is the general population, including pregnant women and mothers of children under five in all districts in Rwanda. Respondents of the survey were restricted to male or females aged 15-49 years old. In total, a sample size of 7,353 households was established using a stratified two-stage cluster sampling approach, aimed at collecting nationally representative data, proportional to province size. The questionaire included questions on the malaria health behaviors of interest (bed net ownership and use and fever treatment) as well as demographic variables and the opportunity, ability, and motivation (OAM) variables

Rwanda (2012): Evaluating and Understanding Living Positively and Secondary Prevention among People Living With HIV

PSI/Rwanda’s HIV prevention program was launched in 1993 alongside the socially marketed condom Prudence. PSI is working with PLHIV through RRP+, a Rwandan Partner Organization (RPO) providing PLHIV with prevention services to live positively and understand their responsibilities in secondary prevention of HIV. For a family which wants to give birth, it is imperative to know they have to comply with prevention of mother to child transmission (PMTCT) guidelines and deliver at the health center or at the hospital. This study aims to identify and understand the lived experiences and sexual practices (of PLHIV) as well as understand the psychosocial factors which influence WHAT?, in order to inform future programmatic decision-making. This qualitative study consisted of 20 in depth interviews with individuals from ten PLHIV associations who self identified themselves as PLHIV. The PLHIV associations were purposely selected and its members stratified by exposed versus non-exposed so that the sample included ten respondents exposed to BCSM interventions and ten respondents not exposed to BCSM interventions