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Rapid Results Initiative for Scaling up Medical Male Circumcision in Kenya

Rapid Results Initiative for Scaling up Medical Male Circumcision in Kenya. Presented by: Elijah Odoyo June Nyanza Reproductive Health Society. Introduction. Kenya launched VMMC in November 2008 (HIV 7%, MC 84%) Objective: Raise MC rate in 15-49 yos from 84-94% in 4 yrs

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Rapid Results Initiative for Scaling up Medical Male Circumcision in Kenya

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  1. Rapid Results Initiative for Scaling up Medical Male Circumcision in Kenya Presented by: Elijah Odoyo June Nyanza Reproductive Health Society

  2. Introduction • Kenya launched VMMC in November 2008 (HIV 7%, MC 84%) • Objective: Raise MC rate in 15-49 yos from 84-94% in 4 yrs • Target: Circumcise 860,000 men in 4 yrs (426,500 in Nyanza ) • Only 50% of first year’s target achieved by end 10 months • RRI approach adopted to address MC service gap

  3. Objectives of RRI • Objective • Accelerate VMMC and circumcise at least 30,000 men in 11 districts of Nyanza province within 30 working days • CT to 80% of MC clients • Seven-day follow up visits for 60% • Strategies • Accelerated public education on MC • Increase access to MC through community outreaches • Strengthen referral from other services to MC ( e.g., CT, STI) • Create structures for RRI coordination at provincial and district levels

  4. MC Service Provision • Minimum MC Service package • Counseling for MC and HIV testing • Clinical examination • Management of STI and other genito-urinary conditions • Surgical excision of foreskin using forceps guided method • Post operative counseling on wound care and abstinence • Seven-day post surgery follow up • MC Service provision team (4) • RCO/Nurse: Surgeon • Nurse/RCO: Assistant Surgeon • MC Counselor, also trained on VCT/PITC • Hygiene/Infection Prevention Officer

  5. Kenya National VMMC guidance documents

  6. Procession during the RRI launch Banner at a health facility inviting MC clients MC educ/consenting; PITC (Note: staff is female) Provincial Director of Health at a MC site

  7. RRI Results • 36,077 MCs (120% achievement) • 28,445 (79%) in 7 of the 11 target districts: • Average10 (8-12) MCs/team/day • 56% tested for HIV during RRI • Men ≥15 year – 55% • Seven day follow up - 23% • Overall AE - 1.9% (1.83%= mod, 0.05% =severe) • For 6,595 returning for F/up: 8.4% AEs (8.2% mod, 0.2% severe) • Deferred or opted out - 694 (256 and 438 respectively)

  8. Weekly Service Output Despite elaborate preparations for RRI, it still took two weeks to attain optimal client flow and overcome logistical bottlenecks

  9. Distribution of VMMC Clients by Age Demand for MC by parents of boys below 12 years was higher than expected

  10. Uptake of HTC by VMMC Clients (28,445) • 2.8% of clients tested on site tested +ve • Despite being HIV +ve 236/303 (79%) opted for circumcision

  11. Key Lessons Learnt • RRI approach effective for scaling up MC • RRI approach builds momentum for public support of MC • The public is ready for MC if services are taken close to them • MC services can be provided safely in diverse settings • RRI for MC is cost effective (Cost/MC down by 56% $ 86-39) • Social mobilization is critical for efficiency • VMMC can help scale up HTC, STI and other RH services

  12. Main challenges • Mismatch between demand and service delivery capacity • Parental consent for boys below legal age of consent • Low uptake of HTC by sexually active men >20yrs • Low seven-day post-surgery follow-up rate • Diversion of attention from routine services

  13. Recommendations • Adopt RRI approach for scaling up MC • For greater impact, integrate RRI for MC with RRI for HTC • Prioritize social mobilization for optimal client flow • Address policy bottlenecks to allow self-consenting by mature minors • Use experience from Kenya to develop a toolkit for conducting RRI for MC in other countries

  14. KawangoAgot, • Walter Obiero • Emma Llewellyn • George Otieno • BenardOdhiambo • Dickens Omondi • Isaac Abuya • OhagaSpala • Isaac Oguma • Zebedee Mwandi • Robert Bailey • Charles Kirui • Edward Owilla • Kennedy Serem, • Jackson Kioko • Peter Cherutich • Nicholas Muraguri Impact Research &Development Organization (IRDO) Ministry of Public Health and Sanitation (MOPHS) Nyanza Reproductive Health Society (NRHS) Catholic Medical Missions Board (CMMB) Family Aids Care and Education Services (FACES) APHIA II Nyanza Family Health International (FHI) Population Services International (PSI) Nyanza Provincial Male Circumcision Taskforce Provincial Commissioner, Nyanza PEPFAR/CDC/USAID National AIDS/STD Control Program Acknowledgement The communities in Nyanza province

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