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Male Circumcision for HIV Prevention in Kenya: Three Years and Counting!

Male Circumcision for HIV Prevention in Kenya: Three Years and Counting!. Dr Peter Cherutich, MD, MPH Head, HIV Prevention & Chair, VMMC Taskforce Ministry of Public Health & Sanitation. International AIDS Conference, Rome, July 17, 2010: Mini Room 1. Burden of HIV.

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Male Circumcision for HIV Prevention in Kenya: Three Years and Counting!

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  1. Male Circumcision for HIV Prevention in Kenya: Three Years and Counting! Dr Peter Cherutich, MD, MPH Head, HIV Prevention & Chair, VMMC Taskforce Ministry of Public Health & Sanitation International AIDS Conference, Rome, July 17, 2010: Mini Room 1

  2. Burden of HIV Province with the highest HIV prevalence (Nyanza) has the lowest MC level Overall HIV Prevalence 6.3%, MC Prevalence-85%

  3. Burden of HIV contd..

  4. Service Delivery Minimum package • Counseling for MC; HIV Testing offered on opt-out basis • Clinical examination • Management of STI and other genito-urinary conditions • Surgical excision of foreskin using forceps guided method • Post operative care • Follow up MC Service provision team (4) • Clinical Officer/Nurse: Surgeon • Nurse/Clinical Officer: Assistant Surgeon • Counselor, also trained on HIV Testing and Counseling • Hygiene/Infection Prevention Officer

  5. Achievements.....290,000 in 3yrs

  6. On course to meet targets...

  7. And in context… Courtesy: Emmanuel Njeuhmeli

  8. Leadership Continued support by political and cultural leaders Government dedication Quick translation of research to Policy and implementation Task-shifting (Clinical Officers and Nurses perform MC) Effective/efficient and passionate implementing partners

  9. Innovation is key...

  10. Opportunities that VMMC provides • Increased access to HIV Prevention &Treatment • Approx 80% coverage of HIV Testing • 30% of men get tested for first time • Assuming 2% HIV prevalence • Identified 6000 new HIV diagnoses • Risk-reduction counseling and condom distribution • STI screening and ? surveillance • During 2010 MC campaign identified 43/55376(<1%) • Revamp/establish male reproductive health • IVU Med/WHO project-47 corrective surgeries • 25 providers trained-skills transfer

  11. Key Lessons Learnt • Deep commitment for impact-driven approach to scale up • Significant population coverage • High intensity-3-5 years • Social change necessary for uptake • Community ownership • Meaningful engagement with political, cultural and social leaders • Efficient delivery mechanisms saves money • Social mobilization, team work, supply chain

  12. ....50% reduction in costs

  13. The future… • Adoption of medical devices • Safer/as safe; cheaper/as cheap; less pain, no anaesthesia, greater flexibility for task shifting • Kenya considering PrePex, Shang Ring, Allisklamp • Continue to explore efficiencies • MOVE concept • Community level ownership and contribution to MCs

  14. Acknowledgements • Ministries of Health • VMMC Taskforce • Male Circumcision Consortium • FHI • NRHS • Engender Health • USG • Gates Foundation • UN family • JaramogiOgingaOdinga Foundation

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