From Research to Practice: Scale-up of Male Circumcision for HIV prevention in Tanzania

1. From Research to Practice: Scale-up of Male Circumcision for HIV prevention in Tanzania Wambura Mwita National Institute for Medical Research Mwanza, Tanzania

2. Background - 1 • Sub-Saharan Africa remains most affected by HIV • 67% PLWA globally in 2007 • 75% AIDS related deaths globally in 2007. • Promoting effective interventions is a priority • Male Circumcision (MC) shown to be efficacious. • WHO/UNAIDS recommends MC

3. Background - 2 Following the 3 trials AND Recommendation by WHO/UNAIDS • A consultative meeting on MC in Sept 2006 • Evidence on the protective effect of MC • Issues around MC within the country • Consensus among stakeholders on MC as additional HIV intervention • NIMR Mwanza had conducted a review • Identify all studies conducted on MC in Tanzania • Lack of info regarding • cultural attitudes on MC • Capacity of Health facilities to deliver safe MC

4. Background -3 Steps agreed by the Consultative Meeting • Conduct situation analysis study to inform strategies for introduction and scale up of MC. • Two Committees should be formed to oversee the operationalization • National taskforce Committee • National Technical Working Group • Names were not identified • Formulation of legal, regulatory and policy framework.

5. Background -4 • WHO developed a situation analysis toolkit • Determine prevalence • Cultural and political attitudes on MC • Capability of medical services to deliver safe MC • WHO organised a training workshop for 13 countries in East and Southern Africa in Harare, Zimbabwe • To familiarise participants with the toolkit • Determine parts of the toolkit relevant in the country context • Agree mechanism of support from UN

6. Background -5 • Prior to Harare • NIMR Mwanza had developed SA protocol • Protocol would be funded by WHO Country office • While in Harare • From a senior officer from NACP- Tanzania • Policy makers have to be part of the entire process • Participation of Donors in scale-up efforts

7. Background -5 • Another national consultative meeting was convened • To form the two taskforces • National technical Working Group (TWG) • National taskforce Committee (NTC) • Preparation of plan of action • TWG workshop in Kibaha • Familiarize participants of TWG on the generic toolkit • TWG to determine parts of the toolkit i.e. relevant to a Tanzanian context. • TWG to plan how, where, resources needed for the SA

8. Progress -1 • A proposal owned by TWG was then finalised and submitted to EC. • NIMR Mwanza is conducting SA under TWG • SA is conducted in 3 Regions in Tanzania • This includes policy reviews and other regulations • National Leadership • Two Committees • A focal person at the MoH

9. Progress -2 • Preparations for demo projects are underway • In 3 Regions of Tanzania • MC included in the R9 application to Global fund for HIV, TB and Malaria • Guidelines for Health Practitioners have been drafted and training started.

10. Discussion-1 • Partnerships involving policy makers, donors, NGOs and researchers • Share knowledge, Experience • Mobilise resourced needed • Recommend: involvement of all stakeholders right from the inception of the project.

11. Discussion -2 • Policy formulation and approval is long process • Requires careful negotiations • Requires money for scaling up programs • Started in Sept 2006 • Recommendation • Need a dedicated new policy or basic enabling environment • Does involvement of donors who are willing to fund the scaling up efforts in low resources countries help?

12. Conclusion • A forum that brings together Policy makers’, Donors, Researchers and NGOs was crucial. • Researcher – decision is based on sound evidence. • Policy makers – owns the entire process. • Donors – funding decisions. • NGOs – Implementation strategies.