Anne Goldzier Thomas PhD DoD HIVAIDS Prevention Program PEPFAR Scaling up Male Circumcision Programmes in the Eastern and Southern Africa Region Country Update Meeting Arusha ID: 814529
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Slide1
Male Circumcision for HIV Prevention in Military Populations
Anne Goldzier Thomas, Ph.D.DoD HIV/AIDS Prevention Program / PEPFAR Scaling –up Male Circumcision Programmes in the Eastern and Southern Africa Region: Country Update Meeting Arusha, TanzaniaJune 8-10, 2010
Slide2Why Male Circumcision in Militaries?
Mostly male populationSexually active – “mobile men with money”Age 18+ with most in lower age groupsLikely to be HIV negativeThey are opinion leaders Nationally representativeService delivery scheduling can be coordinated Follow-up care is availableMonitoring is relatively easyCan add on other male focused prevention and men’s health issues
Slide3Demand Creation and Scheduling
Military tempo provides opportunities for MCRecruits at boot camp – recruit trainingVoluntary Campaign - styleDuties can be lightened post MC for acute healingIdeal -schedule at least 6 weeks before graduationActive duty personnelMC campaignsCoordinate scheduling by medical corpsRoutine clinic procedure
Mobile service delivery to bases
Civilians utilize military health care sites ~ 80%
Slide4Status of Military MC Campaigns
BotswanaSmall scalePlanning MC campaignEthiopiaJust starting for HIV preventionLesothoSmall scaleSelf vs exam MC prevalence studyMozambiquePilot siteNamibia
Just starting
Nigeria
Self
vs
exam MC prevalence study planned
Rwanda
Started and scaling up
Swaziland
Just starting
Tanzania
One site
Uganda
Fixed sites
>300 MCs
Zambia
3 sites and scaling up (+8 2010)
Zimbabwe (private funded)
Slide5Zambia Defence Forces
3 sites currently performing MC 11 sites total are planned for ZDFPhysicians, nurses and clinical officers have been trainedMore providers will be trained to implement at the new sites.M & E system just being implemented
Slide6Namibia Defence Force
Military trained - 41 facility upgradedSite visits and performing MC at civilian facility to keep skills upMOHSS and MOD communicating well on MC; MOD included in planningMOD facilitating volunteer patients to be circumcised as part of MOH surgical trainingMOD starting service delivery week of June 21
Slide7Botswana Defence Force
Participate with MC National Task ForceOne site currently providing MCIntegrated into regular clinic functioningUp to 10 MCs per monthShort-term (~3 months) campaign being planned
Slide8Ethiopia National Defence
Forces ENDF will have MC available for recruits and active duty at selected sitesPlanning for MC just getting startedTraining and service delivery expected to start in 2010
Slide9Umbutfo Swaziland
Defence ForcePlanning for MC provision at Phocweni ClinicSpace renovated for minor surgeryNurse trainedSending USDF to civilian clinicsSupporting civilian MC campaign
Slide10Forces Armadas de Mozambique
Maputo Military Hospital Clients: 10% military / 90% civilian9/2009 – MOD and MOH personnel trained in Zambia, Team of 5 (4 of them from MMH), composed of 2 nurses, 2 GPs and 1 surgeon10/2009 – facilities improved, consumables provided11 / 2009: MC procedures started Large number of MCs performedHigh rate of HIV testing
Slide11Tanzania People’s Defence Force
One site functioning – Mbolisi 97 MCs doneExpansion in planning phase
Slide12Rwanda Defence Force
Conducted MC situational analysisProviders trainedTools and guidelines for MC adapted/developedIEC campaignMC integrated into prevention messagingSupplies and equipment procuredConducting monitoring
Slide13Rwanda Defence Force
Total of 9 sites readiedRefurbishedInfection control improved6 more sites planned50 MC providers trained91 MC counselors trainedAs of April, 2010 – 542 MCs performed
Slide14Uganda People’s Defence
Forces Issue – Buy-inStarting from a no-consensus point, the program conducted:Advocacy meetings
for military commanders,
A guided
tour of a civilian MMC centre and orientation seminars for health
workers .
The
program was piloted in 4 of the
14
Military ART
centers.
Map of Uganda with UPDF MC sites
Slide15Uganda People’s Defence
Forces: 2015 ObjectivesTo increase by 50% from 2010 figures, the prevalence of male circumcision among military populations in UgandaTo strengthen the capacity of UPDF health facilities to provide a minimum package of MMC integrated into existing health care servicesTo raise to 80% among military communities the awareness about MMC services and its benefits, in relation to HIV/AIDS preventions
Slide16Uganda People’s Defence
Forces : Program SpecificsAge: >85% are aged 18-45Sero-status: HIV test done but if HIV+ can still get MCGeographical location: Central, North & Western Uganda. Mobile MC clinics planned for training institutions once leadership buys-in. Providers: Surgical teams of a physician assistant, a counselor and theatre nurse trained to provide the WHO recommended minimal MMC package.
Slide17Uganda People’s
Defence Forces Issue – Vertical Vs Integration UPDF chose integration in routine hospital work over vertical service deliveryEach facility runs a weekly theatre day, performing a maximum 10 circumcisions.
Theatre used for other operations on non-MMC clinic days
Patients
are observed post-operatively for 8 hours and followed up
at 1 week & at 1 month . Bed rest on surgical wards and follow-up in OPD
Slide18Uganda People’s Defence
Forces : Community Engagement Client education materials include Presentation on MCBrochures Posters and
Flip-charts
Integrated MC messages in Peer Education Program
Getting appropriate film show materials still a challenge
Slide19Uganda People’s Defence
Forces : Achievements Actual MCs started in November 2009 in, 3 of the 4 equipped centers 30 health workers trained in MMC service delivery2 advocacy meetings held, reaching 100 military commanders
60 Peer Educators oriented in MMC as HIV prevention strategy
Slide20Uganda People’s Defence
Forces : Achievements IEC materials produced (2,000 commanders fact books, 20,000 patient leaflets)Over 6,000 people reached with educational messages about MMCData tools developed > 300 circumcised
Slide21Uganda People’s Defence
Forces : Human Resource ChallengesTask shifting vs. task sharingNon-Physician providers: Clinical Officer & rarely Medical OfficersTask Sharing not possible due to staffing shortagesFrequent staff transfers: training of critical mass not possible due to limited training opportunities
Slide22Uganda People’s Defence
Forces : Lessons Learnt Huge demand for MCEffective leadership mobilization still crucialTask-shifting enables delivery of MMC services in human
resource constrained
setting
Integration
into routine surgical services
has its limitations and where urgency is needed, vertical MMC programs is
the way to go
.
Slide23Lesotho Defence Force
Conducted self-report vs clinical exam studyOn-going MC for medical purposes and elective for HIV preventionLimited human and infrastructure resources for MC
Slide24US Department of Defense Support
Organizing Self-report vs Examination based prevalence studies in recruit applicant popsMC survey items on surveillance studiesContributing physicians to Swaziland’s ASIVolunteer urologists will be providing training and service delivery support in other countries as requestedDoD will assist with mobile medical facilities
Slide25Infrastructure Considerations
Slide26Summary
Military populations are excellent target populations for MCMilitary populations can catalyze civilian populations to embrace the interventionCatch up campaigns are crucial to reduce HIV infection on a meaningful scale in a reasonable time periodAdditional human and material resources are needed for militaries to provide MC
Slide27Education
Slide28MC Drama Sketches
Slide29Gender Involvement
Slide30Condom Use Skills Building
Slide31Group Counseling Session
Slide32Strong Leadership Support
Slide33Thank You!
Slide34Acknowledgements
Dr. Charles Murego Dr. Aune Victor
Mr. Eugene
Zimulinda
Ms. Becky
Cathcart
Dr. Vincent
Bagambe
PEPFAR MC Task Force
Mr. Antonio
Langa
Mr. Patrick Kunene
Ms.
Eda
Lufika
PSI
Mr.
Teka
Tesfaye
Jphiego
Mr. David
Kelapile
Ms.
Malerato
Brown