Voluntary medical male circumcision programs can address low HIV testing and counseling usage and ART enrollment among young men: lessons from Lesotho.

Early diagnosis of HIV and treatment initiation at higher CD4 counts improves outcomes and reduces transmission. However, Lesotho is not realizing the full benefits of ART because of the low proportion of men tested (40%). Public sector VMMC services, which were launched in district hospitals in February 2012 by the Lesotho MOH supported by USAID/MCHIP, include HIV testing with referral to care and treatment. The objective of this study was to better understand the contribution of VMMC services to HIV diagnosis and treatment.VMMC clients diagnosed with HIV were traced after 6 months to ascertain whether they: (1) presented to the referral HIV center, (2) had a CD4 count done and (3) were enrolled on ART. Linkages between VMMC and HIV services were assessed by comparing the proportion of HIV-infected males referred from VMMC services with those from other hospital departments.Between March and September 2012, 72 men presenting for VMMC services tested positive for HIV, representing 65% of the total male tests at the hospital; 45 of these men (62.5%) received an immediate CD4 count and went to the HIV referral site; 40 (89%) were eligible for treatment and initiated ART. 27 clients did not have a CD4 count due to stock-out of reagents. Individuals who did not receive a CD4 count on the same day did not return to the HIV center.All VMMC clients testing positive for HIV and receiving a CD4 count on the testing day began ART. Providing VMMC services in a district hospital offering the continuum of care could increase diagnoses and treatment uptake among men, but requires an investment in communication between VMMC and ART clinics. In high HIV prevalence settings, investing in PIMA CD4 devices at integrated VMMC clinics is likely to increase male ART enrolment

Flow chart describing ART enrolment outcome of VMMC clients who tested HIV-positive.

<p>All clients who received a CD4 count and who were eligible while seeking VMMC services were initiated on ART. Among the 27 clients who did not receive a CD4 count while seeking VMMC services, only four were enrolled in treatment.</p

Percentage Age Distribution of Total Male Population, Zimbabwe.

<p>Percentage Age Distribution of Total Male Population, Zimbabwe.</p

Percentage Age Distribution of Total Male Population in Tanzania (all regions).

<p>Percentage Age Distribution of Total Male Population in Tanzania (all regions).</p

Total number of VMMC procedures in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.

<p>Total number of VMMC procedures in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.</p

Percent distribution of circumcisions by intensity of service (campaign vs. routine), Zimbabwe, 2009–2012.

<p>Percent distribution of circumcisions by intensity of service (campaign vs. routine), Zimbabwe, 2009–2012.</p

Percentage distribution of VMMC procedures by intensity (campaign vs. routine), in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.

<p>Percentage distribution of VMMC procedures by intensity (campaign vs. routine), in Iringa and Njombe regions, Tanzania, October 2009 to December 2012.</p

Percentage age distribution of VMMC clients in Zimbabwe, by 2009–2012.

<p>Percentage age distribution of VMMC clients in Zimbabwe, by 2009–2012.</p