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Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania


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.


Vyšlo v časopise: Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania. PLoS Med 8(11): e32767. doi:10.1371/journal.pmed.1001131
Kategorie: Review
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001131

Souhrn

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.


Zdroje

1. AuvertBTaljaardDLagardeESobngwi-TambekouJSittaR 2005 Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2 e298 doi:10.1371/journal.pmed.0020298

2. BaileyRCMosesSParkerCBAgotKMacleanI 2007 Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 369 643 656

3. GrayRHKigoziGSerwaddaDMakumbiFWatyaS 2007 Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 369 657 666

4. World Health Organization, Joint United Nations Programme on HIV/AIDS 2007 New data on male circumcision and HIV prevention: policy and programme implications. Available: http://libdoc.who.int/publications/2007/9789241595988_eng.pdf. Accessed 18 September 2011

5. World Health Organization, Joint United Nations Programme on HIV/AIDS, Jhpiego 2009 Manual for male circumcision under local anaesthesia, version 2.5. Geneva: World Health Organization. Available: http://www.who.int/hiv/pub/malecircumcision/who_mc_local_anaesthesia.pdf. Accessed 18 September 2011

6. World Health Organization 2010 Considerations for implementing models for optimizing the volume and efficiency of male circumcision services for HIV prevention. Geneva World Health Organization

7. Tanzania Commission for AIDS, Zanzibar AIDS Commission, National Bureau of Statistics, Office of the Chief Government Statistician, Macro International 2008 Tanzania HIV/AIDS and malaria indicator survey: 2007–08. Dar es Salaam (Tanzania): Tanzania Commission for AIDS. Available: http://www.tacaids.go.tz/dmdocuments/THMIS%202007-08.pdf. Accessed 18 September 2011

8. Tanzania National Institute for Medical Research, Tanzania Ministry of Health and Social Welfare 2009 Situation analysis for male circumcision in Tanzania: final report. Dar es Salaam (Tanzania): National Institute for Medical Research. Available: http://malecircumcision.org/programs/documents/TanzaniaMaleCircumcisionSituationAnalysis_September_09.pdf. Accessed 1 November 2011

9. National AIDS Control Programme 2010 National strategy for scaling up male circumcision for HIV prevention: enhancing men's role in HIV prevention. Dar es Salaam (Tanzania) National AIDS Control Programme

10. NjeuhmeliEForsytheSReedJOpuniMBollingerL 2011 Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS Med 8 e1001132 doi:10.1371/journal.pmed.1001132

11. Tanzania Prime Minister's Office, Regional Commissioner's Office 2010 Iringa regional action plan for the prevention of new HIV infections (July 2010–June 2012). Iringa Tanzania Prime Minister's Office

12. PlotkinMKüverJCurranKMzirayHPrinceJ 2011 Embe Halijamenywa: the unpeeled mango. A qualitative assessment of views and preferences concerning voluntary medical male circumcision in Iringa Region, Tanzania. Available: http://www.mchip.net/sites/default/files/The%20Unpeeled%20Mango%20-%20Final%20Report%202011.pdf. Accessed 25 October 2011

13. Maternal and Child Health Integrated Program/Tanzania 2010 Male circumcision service delivery data from Iringa region, November 2009 to May 2010. Dar es Salaam (Tanzania) Jhpiego

Štítky
Interné lekárstvo

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PLOS Medicine


2011 Číslo 11
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